Respiratory medicine
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Respiratory medicine · Jul 2010
Randomized Controlled Trial Multicenter StudyCombining tiotropium and salmeterol in COPD: Effects on airflow obstruction and symptoms.
Clinical information on 24-h spirometric efficacy of combining tiotropium and salmeterol compared to single-agent therapy is lacking in patients with COPD. ⋯ Compared to single-agent therapy, combination therapy of tiotropium plus salmeterol in COPD provided clinically meaningful improvements in airflow obstruction and dyspnea as well as a reduction in reliever medication.
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Respiratory medicine · Jul 2010
Randomized Controlled TrialA randomized controlled trial of cognitive behavioral therapy for anxiety and depression in COPD.
Previous research indicates a high prevalence of untreated anxiety and depression in patients with chronic obstructive pulmonary disease (COPD). The current study examined the effect of cognitive behavioral therapy (CBT) in groups for co-morbid, clinically significant anxiety and depression in COPD outpatients of both sexes. ⋯ The findings indicate that CBT may provide rapid symptom relief for COPD patients with clinically significant anxiety and depression, and underline the need for integrating mental health care into the overall medical regimen for COPD.
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Respiratory medicine · Jul 2010
Practice GuidelineThe ERS guidelines for LAM: trying a rationale approach to a rare disease.
Lymphangioleiomyomatosis (LAM) is a rare lung disease which predominantly affects young women. LAM is associated with much morbidity and can lead to respiratory failure and death unless lung transplantation is performed. There are no randomised trials of treatment and no consensus on the management of LAM. ⋯ All aspects of management from advice for patients to lung transplantation are discussed. To demonstrate how the guidelines have dealt with different areas of practice and differing evidence levels the specific areas of hormonal therapy, pneumothorax and lung transplantation for LAM are discussed. It is hoped that these guidelines will result in standardisation of diagnostic criteria and patient management which will further improve clinical care and facilitate research and clinical trials.
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Respiratory medicine · Jul 2010
Lymphangioleiomyomatosis (LAM): molecular insights lead to targeted therapies.
LAM is a rare lung disease, found primarily in women of childbearing age, characterized by cystic lung destruction and abdominal tumors (e.g., renal angiomyolipoma, lymphangioleiomyoma). The disease results from proliferation of a neoplastic cell, termed the LAM cell, which has mutations in either of the tuberous sclerosis complex (TSC) 1 or TSC2 genes. Molecular phenotyping of LAM patients resulted in the identification of therapeutic targets for drug trials. ⋯ The metastatic properties of LAM cells offer additional potential for targets. Thus, insights into the molecular and biological properties of LAM cells and molecular phenotyping of patients with LAM have led to clinical trials of targeted therapies. Funded by the Intramural Research Program, NIH/NHLBI.
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Respiratory medicine · Jul 2010
Therapeutic options for systemic sclerosis related interstitial lung diseases.
Interstitial lung disease (ILD) is a common manifestation of systemic sclerosis (SSc) mainly encountered in patients with diffuse disease. Unlike idiopathic interstitial pneumonias (IIP), SSc associated ILD corresponds to non-specific interstitial pneumonia (NSIP) in most cases, whereas usual interstitial pneumonia (UIP) is encountered less frequently. This explains the better prognosis of SSc associated ILD compared to IIP. ⋯ Anti-fibrosing treatments have failed to demonstrate any benefit and cyclophosphamide, which has been used in the treatment of this condition for about 15 years, has recently been evaluated in two prospective randomised studies which showed a significant but modest effect on respiratory function. Since none of the patients included in retrospective or prospective studies were selected on the basis of progression of ILD, and since only a minority of SSc patients develop severe ILD, further studies should focus on the subgroup of SSc patients with worsening ILD. A subgroup of patients with rapidly progressive ILD might benefit from pulsed intravenous cyclophosphamide combined with prednisone 15 mg daily but this remains to be confirmed.