Expert review of respiratory medicine
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Expert Rev Respir Med · Dec 2019
ReviewThe pragmatic role of FEF25-75 in asymptomatic subjects, allergic rhinitis, asthma, and in military setting.
Introduction: The forced expiratory flow between 25% and 75% of forced vital capacity (FEF25-75) is a spirometry parameter that may be useful in many clinical settings. Values <65% of predicted have been defined as abnormal. Areas covered: The current report discusses the clinical value of FEF25-75 in different settingv, namely military medicine, primary care, and specialized clinic. ⋯ The most recent literature concerning the assessment of FEF25-75 in these covered areas was searched. Expert opinion: In clinical practice, impaired values have been defined as a reliable surrogate marker for bronchial airflow limitation associated with early onset of asthma, bronchial hyperresponsiveness, lower airway inflammation, reversibility to bronchodilation testing, allergic sensitization, and uncontrolled asthma. In the military medicine setting, simple spirometry, including FEF25-75, may suggest a series of fruitful information.
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Expert Rev Respir Med · Dec 2019
ReviewTreatment of idiopathic pulmonary fibrosis with Nintedanib: an update.
Introduction: Idiopathic pulmonary fibrosis (IPF) is an incurable, progressive and debilitating disease. Nintedanib is one of two anti-fibrotic therapies available for the treatment of IPF and has been approved since 2014. ⋯ Expert opinion: Nintedanib significantly slows disease progression in IPF patients with tolerable and manageable side effects. Its potential future role in the treatment of progressive fibrosing interstitial lung diseases other than IPF is challenging.
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Expert Rev Respir Med · Dec 2019
Comparative StudyComparison of unsupervised home-based pulmonary rehabilitation versus supervised hospital outpatient pulmonary rehabilitation in patients with chronic obstructive pulmonary disease.
Background: Pulmonary rehabilitation (PR) is an effective treatment in patients with chronic obstructive pulmonary disease (COPD) but still underutilized. The aim of this study was to compare unsupervised home PR with supervised outpatient PR in terms of various clinical variables in COPD patients. Methods: We conducted retrospective study consisting of 247 patients with COPD who were categorized into three group. 127 patients underwent unsupervised home PR, of whom 60 (47%) completed program (finishers), 67(53%) were lost to follow-up (non-finishers), 120 completed supervised outpatient PR. ⋯ Improvements in exercise capacity (p < 0.05), quality of life (p < 0.001), dyspnea (p = 0.023), anxiety (p < 0.001), depression (p = 0.001) scores were different between completed PR programs, in favor of supervised outpatient PR. Non-finishers of home PR had more pack-year smoking than finishers of home PR (p = 0.039); other baseline parameters were similar. Conclusion: Unsupervised home PR was effective in terms of improving exercise capacity, quality of life, dyspnea, psychological status, but less than supervised outpatient programs.
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Expert Rev Respir Med · Dec 2019
Mepolizumab for severe eosinophilic asthma: a real-world snapshot on clinical markers and timing of response.
Background: Few studies have provided real-world evidence of mepolizumab efficacy and safety. We aimed to evaluate mepolizumab for severe eosinophilic asthma in daily clinical practice. Research design and methods: Patients included in the RINOVA (Interdisciplinary Network for the management of severe asthma in Veneto region, Italy) database were investigated. ⋯ A significant reduction of FeNO was observed six months after the treatment start, when the exacerbation rate and the mean OCS dose significantly decreased (respectively: Δ reduction -3; p < 0.001 and -5 mg; p < 0.001). Conclusions: Our study provides real-world evidence of mepolizumab safety and confirms its dramatic steroid sparing effect. The greatest clinical change (ACT and FEV1) was observed within the first month.
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Expert Rev Respir Med · Aug 2019
ReviewManagement of ventilator-associated pneumonia (VAP) caused by resistant gram-negative bacteria: which is the best strategy to treat?
Introduction: Treatment of ventilator-associated pneumonia (VAP) is a major challenge. The increase in multi-drug resistant bacteria has not been accompanied by the validation of new drugs, or by any new antimicrobial strategies to exploit the available agents. VAP due to Gram-negative bacteria has increased mortality, both due to the resistant pathogens themselves and due to inappropriate treatment. ⋯ Expert opinion: The existing evidence focuses on bloodstream infections or other sites rather than pneumonia and there are no recommendations for the treatment of VAP by multi-drug resistant Gram-negative bacteria, especially for combination regimens. The approval of new drugs is needed to provide effective and safe alternatives for treating carbapenemase-producing strains. Precision medicine and personalized approach are also fundamental in future research.