Therapeutic advances in respiratory disease
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Bronchial thermoplasty is a new treatment option for patients with severe bronchial asthma who remain symptomatic despite maximal medical therapy. The aim of this interventional therapy option is the reduction of smooth muscle in the central and peripheral airways in order to reduce symptomatic bronchoconstriction via the application of heat. A full treatment with bronchial thermoplasty is divided into three bronchoscopies. ⋯ Short-term adverse effects include an increase in exacerbation rate, an increase in respiratory infections and an increase in hospitalizations. In the 5-year follow up of the studies available there was evidence of clinical and functional stability of the treated patients. Further studies are necessary to identify an asthma phenotype that responds well to this treatment.
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Ther Adv Respir Dis · Feb 2014
Comparison of outcomes following stereotactic body radiotherapy for non-small cell lung cancer in patients with and without pathological confirmation.
Treatment of presumed early-stage lung cancer with definitive radiation therapy in the absence of a pathologically confirmed specimen frequently occurs. However, it is not well described in the literature, and there are few North American series reporting on this patient population. We report outcomes in patients treated with stereotactic body radiotherapy (SBRT) for presumed lung cancer and compare them to outcomes in patients treated with SBRT with pathologically confirmed non-small cell lung cancer (NSCLC). ⋯ While biopsy confirmation remains a goal in the workup of suspected NSCLC, SBRT without pathologic confirmation may represent a safe and effective option for the treatment of presumed NSCLC among patients who cannot tolerate or refuse surgery.
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Ther Adv Respir Dis · Dec 2013
ReviewThe combination of umeclidinium bromide and vilanterol in the management of chronic obstructive pulmonary disease: current evidence and future prospects.
The defining feature of chronic obstructive pulmonary disease (COPD) is progressive airflow limitation that causes air trapping and hyperinflation. The increasing hyperinflation results in dyspnea along with associated inability to engage in the activities of daily living. The American Thoracic Society (ATS), European Respiratory Society (ERS) and Global Initiative for Chronic Obstructive Lung Disease (GOLD) treatment guidelines all place bronchodilators as the foundation of pharmacological management of COPD. ⋯ Thus, UMEC/VI has become the first FDC LAMA/LABA product that has reached a regulatory approval stage. Other LAMA/LABA once-daily combinations coming through development include FDCs of tiotropium and olodaterol, glycopyrronium and indacaterol, and twice-daily aclidinium and formoterol. The aim of this review is to explore currently available data for once-daily UMEC/VI in the context of the evolving standards of COPD management.
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Ther Adv Respir Dis · Dec 2013
ReviewImproving end-of-life care for patients with chronic obstructive pulmonary disease.
The provision and awareness of the need for end-of-life care has expanded greatly in the past decade. The burgeoning older adult population is obviously a factor in the growth of both hospice and palliative care organizations. ⋯ Healthcare professionals have stepped up their initiatives to educate both the patient and family members about the options available to them at the end of life, however many patients with chronic obstructive lung disease (COPD) still do not receive adequate palliation of symptoms. This article will highlight some of the issues related to end-of-life care for individuals diagnosed with COPD and offer suggestions on how better care can be implemented.
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Treatment of latent tuberculosis (TB) infection is an important component of TB control programs in both high- and low-prevalence countries. Clinical trials of treatment of latent TB conducted over several decades have demonstrated that preventive treatment can reduce the risk of developing active TB up to 90%. ⋯ Most recently, a 12-dose regimen of once-weekly isoniazid and rifapentine has been shown to be noninferior to 9 months of daily isoniazid in a large and well conducted clinical trial. Adoption of such a regimen on a large scale could have significant implications for TB elimination efforts.