American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Feb 2012
Practice GuidelineAn official American Thoracic Society statement: update on the mechanisms, assessment, and management of dyspnea.
Dyspnea is a common, distressing symptom of cardiopulmonary and neuromuscular diseases. Since the ATS published a consensus statement on dyspnea in 1999, there has been enormous growth in knowledge about the neurophysiology of dyspnea and increasing interest in dyspnea as a patient-reported outcome. ⋯ Progress in treatment of dyspnea has not matched progress in elucidating underlying mechanisms. There is a critical need for interdisciplinary translational research to connect dyspnea mechanisms with clinical treatment and to validate dyspnea measures as patient-reported outcomes for clinical trials.
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Am. J. Respir. Crit. Care Med. · Feb 2012
Clinical TrialAcute upper airway responses to hypoglossal nerve stimulation during sleep in obstructive sleep apnea.
Hypoglossal nerve stimulation (HGNS) recruits lingual muscles, reduces pharyngeal collapsibility, and treats sleep apnea. ⋯ HGNS produced marked dose-related increases in airflow without arousing patients from sleep. Increases in airflow were of sufficient magnitude to eliminate IFL in most patients and IFL and non-IFL subgroups achieved normal or near-normal levels of flow, suggesting potential HGNS efficacy across a broad range of sleep apnea severity.
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Am. J. Respir. Crit. Care Med. · Feb 2012
Variable DNA methylation is associated with chronic obstructive pulmonary disease and lung function.
Chronic obstructive pulmonary disease (COPD) is associated with local (lung) and systemic (blood) inflammation and manifestations. DNA methylation is an important regulator of gene transcription, and global and specific gene methylation marks may vary with cigarette smoke exposure. ⋯ Genetic and epigenetic pathways may both contribute to COPD. Many of the top associations between COPD and DNA methylation occur in biologically plausible pathways. This large-scale analysis suggests that DNA methylation may be a biomarker of COPD and may highlight new pathways of COPD pathogenesis.
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Am. J. Respir. Crit. Care Med. · Feb 2012
Heart rate recovery predicts clinical worsening in patients with pulmonary arterial hypertension.
Reduced heart rate recovery after exercise is associated with increased mortality in cardiopulmonary diseases. ⋯ HRR1 after 6MW test is a strong predictor of clinical worsening and TCW in patients with IPAH. The addition of HRR1 to 6MWD increases the capacity of 6MWD to predict clinical worsening and TCW in patients with IPAH.