Respiratory medicine
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Respiratory medicine · Oct 2014
ReviewLong-term macrolide maintenance therapy in non-CF bronchiectasis: evidence and questions.
Macrolide antibiotics have anti-inflammatory and immunomodulatory properties in addition to antibacterial activity. Until recently, only a small number of studies evaluating macrolides in patients with non-cystic fibrosis (CF) bronchiectasis had been published. These were open-label, uncontrolled, short-duration studies that included small numbers of patients. ⋯ The advantages of macrolide maintenance therapy need to be balanced against the risks, which include emergence of bacterial resistance, cardiotoxicity and ototoxicity. In addition, a key need is the consistent definition of endpoints for studies in non-CF bronchiectasis, particularly the definition of exacerbation, to allow systematic data analysis. Existing studies on the use of low-dose macrolides in non-CF bronchiectasis are encouraging, but further studies are needed to define the optimal agent, dose, duration for treatment, and the patients likely to benefit and long-term safety.
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Respiratory medicine · Oct 2014
Randomized Controlled TrialVolume assured versus pressure preset non-invasive ventilation for compensated ventilatory failure in COPD.
The addition of domiciliary non-invasive ventilation (NIV) to standard therapy in chronic obstructive pulmonary disease (COPD) patients with compensated ventilatory failure (CVF) is reported to have beneficial effects. Compliance with NIV is an important factor. Volume assured NIV (va-NIV) may improve compliance and ventilation during sleep by automatically titrating ventilatory pressures. ⋯ Domiciliary va-NIV and pp-NIV have similar effects on physiological outcomes in COPD patients with CVF and both are well tolerated.
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Respiratory medicine · Oct 2014
Randomized Controlled TrialPooled safety analysis of the fixed-dose combination of indacaterol and glycopyrronium (QVA149), its monocomponents, and tiotropium versus placebo in COPD patients.
To further assess the safety profile of the fixed-dose combination of indacaterol and glycopyrronium (QVA149) and its monocomponents; we investigated the impact of individual patient-level factors and time by integrating the patient-level safety data from the QVA149 clinical programme with relevant information from the independent indacaterol and glycopyrronium safety databases. ⋯ There was no increase in the risk for the investigated safety endpoints for the fixed-dose combination QVA149, and it had a comparable safety profile as its monocomponents and tiotropium versus placebo.
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Respiratory medicine · Oct 2014
Phenotypic and genetic heterogeneity among subjects with mild airflow obstruction in COPDGene.
Chronic obstructive pulmonary disease (COPD) is characterized by marked phenotypic heterogeneity. Most previous studies have focused on COPD subjects with FEV1 < 80% predicted. We investigated the clinical and genetic heterogeneity in subjects with mild airflow limitation in spirometry grade 1 defined by the Global Initiative for chronic Obstructive Lung Disease (GOLD 1). ⋯ Our results indicate that GOLD 1 subjects show substantial clinical heterogeneity, which is at least partially related to genetic heterogeneity.
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Respiratory medicine · Oct 2014
Lung cancer in patients with idiopathic pulmonary fibrosis: clinical characteristics and impact on survival.
Idiopathic pulmonary fibrosis (IPF) is reportedly associated with an increased risk of lung cancer. However, few studies have explored whether IPF affects the long-term survival of lung cancer patients. The primary goal of this study was to evaluate the characteristics of lung cancer in IPF patients and impact of IPF on lung cancer survival. ⋯ Squamous cell carcinoma was the most common type of lung cancer in IPF patients. IPF reduced the survival of surgically treated lung cancer patients regardless of age, sex, histologic type, and/or lung cancer stage.