Therapeutic advances in respiratory disease
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Ther Adv Respir Dis · Jan 2018
Extended-release oral treprostinil in the management of pulmonary arterial hypertension: clinical evidence and experience.
Treprostinil diolamine is the first oral prostacyclin approved for the treatment of pulmonary arterial hypertension (PAH) to improve exercise capacity. Clinical studies have demonstrated modest benefit as monotherapy, whereas no difference in exercise capacity was observed with combination therapy. However, these trials were limited by subtherapeutic dosing owing to intolerable adverse effects. ⋯ Oral treprostinil has also been studied in carefully selected, stable patients that transitioned from parenteral or inhaled therapy with close monitoring for late deterioration. Ongoing clinical trials will determine the long-term effects of higher doses of oral treprostinil on clinical outcomes. This review describes the clinical evidence and practical experience with the use of oral treprostinil for PAH.
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Ther Adv Respir Dis · Jan 2018
Randomized Controlled Trial Comparative StudyInfluence of the Vibralung Acoustical Percussor on pulmonary function and sputum expectoration in individuals with cystic fibrosis.
The Vibralung Acoustical Percussor is a new airway clearance therapy (ACT) utilizing intrapulmonary sound waves in addition to positive expiratory pressure (PEP). We evaluated the safety of the Vibralung and collected preliminary data on its ability to mediate sputum expectoration in individuals with cystic fibrosis (CF). ⋯ Vibralung was well tolerated and caused no detrimental changes in pulmonary function metrics. The Vibralung appears to be a safe ACT in individuals with CF.
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Ther Adv Respir Dis · Jan 2018
Multicenter Study Observational StudyUse of glucocorticoids in patients with COPD exacerbations in China: a retrospective observational study.
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are common in patients with underlying moderate to severe COPD and are associated with increased health and economic burden. International and Chinese guidelines recommend using glucocorticoids for the management of AECOPD because glucocorticoid therapy has been shown to benefit clinical outcomes. However, only scant data are available for current status of glucocorticoid therapy in hospitalized AECOPD patients in China. The aim of the study was to identify current use of glucocorticoids for the treatment of AECOPD in China. ⋯ Our study was the first study of the treatment pattern of glucocorticoids in the management of hospitalized AECOPD patients in China. Data indicates that there is a gap in the implementation of international guidelines for the treatment of AECOPD in China. Further studies are warranted to clarify the appropriate glucocorticoids strategy for the management of AECOPD to determine the optimal route of administration, dose and duration, and resulting clinical outcomes.
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Ther Adv Respir Dis · Jan 2018
ReviewNintedanib in the management of idiopathic pulmonary fibrosis: clinical trial evidence and real-world experience.
Idiopathic pulmonary fibrosis (IPF) is a fibrotic interstitial lung disease associated with significant morbidity and mortality. Previously, IPF has been managed using immunosuppressive therapy; however, it has been shown that this is associated with increased mortality. In the last 5 years, two disease-modifying agents have been licensed for use in IPF, namely pirfenidone and nintedanib. ⋯ Gastrointestinal events, mainly diarrhoea, are the main adverse events caused by the treatment. Recent real-word studies also suggest that nintedanib stabilizes lung function till lung transplantation, with no increased surgical complications or postoperative mortality after lung transplantation. In this review, we will discuss the clinical trial evidence and real-world experience for nintedanib in the management of IPF.
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Ther Adv Respir Dis · Jan 2018
ReviewElectronic cigarettes: an aid in smoking cessation, or a new health hazard?
The issue of electronic cigarettes is one of the most controversial topics in public health. There is intense debate and dividing opinions about their use patterns, health effects and association with smoking. ⋯ Three main factors determine the public health impact of electronic cigarettes: (1) their safety/risk profile, both relative to smoking and in absolute terms; (2) their effectiveness for smoking reduction and cessation; (3) the patterns of use by different population subgroups, especially never-smokers, and adoption of use by youth. This analysis presents a brief overview of currently available evidence and gaps in research covering these three factors.