Current opinion in pulmonary medicine
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Several lung volume reduction (LVR) techniques have been increasingly evaluated in patients with advanced pulmonary emphysema, especially in the last decade. Radiologist plays a pivotal role in the characterization of parenchymal damage and, thus, assessment of eligibility criteria. This review aims to discuss the most common LVR techniques, namely LVR surgery, endobronchial valves, and coils LVR, with emphasis on the role of computed tomography (CT). ⋯ CT characterization of heterogeneous parenchymal abnormalities provides criteria for selection of the preferable treatment in each patient and improves outcome of LVR as reflected by better quality of life, higher exercise tolerance, and lower mortality.
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Despite decades of scientific attention, chronic obstructive pulmonary disease (COPD) remains a major cause of both morbidity and mortality worldwide with strikingly few effective drug classes available. This may be in part because COPD is actually a syndrome composed of distinct diseases with varying pathophysiology (endotypes), and therapies have not been designed to target the causal pathological processes specific to an endotype. ⋯ Further work characterizing COPD endotypes, including this neutrophilic endotype, will be important as we strive to understand the mechanistic roots of this disease in the hope of creating more effective therapies.
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Asthma is quite common and is better described as a syndrome with a heterogeneous presentation than as a single disease. Although most individuals can be effectively managed using a guideline-directed approach to care, those with the most severe illness may benefit from a more targeted therapy. The review describes our current understanding of how asthma phenotypes (observable characteristics) and endotypes (specific biologic mechanisms) can be employed to gain insight into asthma pathobiology and personalized therapy. ⋯ Asthma is a heterogeneous condition with diverse characteristics and biologic mechanisms. Severe asthma is associated with significant morbidity and even mortality and represents a major unmet need. Stratification of asthma subtypes into phenotypes and endotypes should move the field forward in terms of more effective and personalized treatment.
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Severe asthma is a heterogeneous syndrome. Classification of asthma into phenotypes and endotypes can improve understanding and treatment of the disease. Identification and utilization of biomarkers, particularly those linked to T2 inflammation, can help group patients into phenotypes, predict those who will respond to a specific therapy, and assess the response to treatment. ⋯ Despite advances in the identification and utilization of asthma biomarkers, further studies are needed to better clarify the role of biomarkers, individually or in combination, in the diagnosis and treatment of severe asthma. Future therapeutic trials should include the use of biomarkers in their design, which may lead to a more personalized approach to therapy and improved outcomes.
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MRI has emerged as radiation-free imaging modality for assessment of cystic fibrosis lung disease. Here, we review the current status and new developments of MRI in cystic fibrosis. ⋯ MRI is sensitive to detect hallmarks of cystic fibrosis lung disease such as bronchial wall thickening, bronchiectasis, mucus plugging and abnormal lung perfusion. A morpho-functional MRI score has been established for semiquantitative assessment of these characteristic abnormalities over a broad range of disease severity. Recent studies demonstrated that MRI is sensitive to detect changes in mucus plugging and lung perfusion in response to antibiotic therapy for pulmonary exacerbations. These results suggest that MRI may be suitable for noninvasive monitoring and as a quantitative endpoint in clinical trials for cystic fibrosis. Technical advances including ultra-short echo time and Fourier decomposition imaging are expected to enhance morphological and functional MRI of cystic fibrosis lung disease without the need of contrast medium in the near future.