American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Oct 2015
ReviewCirculating sRAGE as a Biomarker of Emphysema and the RAGE Axis in the Lung.
Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous disease that has been traditionally characterized by incompletely reversible airflow limitation. Yet, the latter is poorly correlated with many other clinically relevant characteristics of the disease. Thus, the identification of biomarkers to more accurately assess this heterogeneity and disease severity may facilitate the discovery and development of new treatments and better management of patients with COPD. ⋯ Multiple reports have now linked sRAGE to COPD, and more specifically to emphysema, and evidence is accumulating that this link is likely mechanistic in nature. Here we review the current state of knowledge about sRAGE biology, the mechanistic links to COPD, and the evidence for using it as a biomarker for emphysema. We also discuss sRAGE as a potential target for therapeutic intervention in COPD.
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Am. J. Respir. Crit. Care Med. · Oct 2015
Comparative StudySustained Benefit from Ivacaftor Demonstrated by Combining Clinical Trial and CF Patient Registry Data.
In clinical trials, patients with cystic fibrosis and a G551D mutation who received ivacaftor experienced improvements in pulmonary and nutritional outcomes. However, whether these improvements reflect a change in disease trajectory cannot be determined without longer-term analyses with an appropriate comparator population. ⋯ These findings suggest that ivacaftor is a disease-modifying therapy for the treatment of cystic fibrosis.
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In aging populations, the commonly used Global Initiative for Chronic Obstructive Lung Disease (GOLD) may misclassify normal spirometry as respiratory impairment (airflow obstruction and restrictive pattern), including the presumption of respiratory disease (chronic obstructive pulmonary disease [COPD]). ⋯ GLI-defined normal spirometry, even when classified as respiratory impairment by GOLD, included adjusted mean values in the normal range for multiple phenotypes. These results suggest that among adults with GLI-defined normal spirometry, GOLD may misclassify normal phenotypes as having respiratory impairment.
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Am. J. Respir. Crit. Care Med. · Oct 2015
Observational StudyThe Utility of Preoperative Six-Minute Walk Distance in Lung Transplantation.
The use of 6-minute-walk distance (6MWD) as an indicator of exercise capacity to predict postoperative survival in lung transplantation has not previously been well studied. ⋯ 6MWD is significantly associated with post-transplant survival and is best incorporated into transplant evaluations on a continuous basis given limited ability of a single, dichotomous value to predict outcomes.
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Am. J. Respir. Crit. Care Med. · Oct 2015
Observational StudyBedside Assessment of Quadriceps Muscle Using Ultrasound Following Admission for Acute Exacerbations of Chronic Respiratory Disease.
Hospitalization represents a major event for the patient with chronic respiratory disease. There is a high risk of readmission, which over the longer term may be related more closely to the underlying condition of the patient, such as skeletal muscle dysfunction. ⋯ Smaller quadriceps muscle size, as measured by ultrasound in the acute care setting, is an independent risk factor for unscheduled readmission or death, which may have value both in clinical practice and for risk stratification.