Pulmonary pharmacology & therapeutics
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Pulm Pharmacol Ther · Dec 2016
Review Meta AnalysisLack of efficacy of nebulized magnesium sulfate in treating adult asthma: A meta-analysis of randomized controlled trials.
Nebulized magnesium sulfate (MgSO4) has been used to treat asthma, but the efficacy remains controversial. We aimed to comprehensively review the efficacy of nebulized MgSO4 in treating adult patients with asthma. ⋯ Evidence to date suggests that nebulized MgSO4 has no role in the management of adult patients with acute or stable asthma.
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Pulm Pharmacol Ther · Dec 2016
ReviewEvaluating the role of leukotriene-modifying drugs in asthma management: Are their benefits 'losing in translation'?
Leukotrienes (LTs) initiate a cascade of reactions that cause bronchoconstriction and inflammation in asthma. LT-modifying drugs have been proved very effective to reduce inflammation and associated exacerbation however despite some illustrious clinical trials the usage of these drugs remains overlooked because the evidence to support their utility in asthma management has been mixed and varied between studies. Although, there are plenty of evidences which suggest that the leukotriene-modifying drugs provide consistent improvement even after just the first oral dose and reduce asthma exacerbations, the beneficial effect of these drugs has remained sparse and widely debated. ⋯ Therefore, in the present era of personalized medicine, it is important to properly stratify the patients and non-invasive measurements of biomarkers may warrant the possibility to characterize biological/pathological pathway to direct treatment to those who will benefit from it. Endotyping based on individual's leukotriene levels should probably ascertain a subgroup of patients that would clearly benefit from the treatment even though the trial fails to show overall significance. In this article, we have methodically evaluated contemporary literature describing the efficacy of LT-modifying drugs in the management of asthma and highlighted the importance of phenotyping the asthmatics for better treatment outcomes.
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Pulm Pharmacol Ther · Oct 2016
Review Meta AnalysisPirfenidone, nintedanib and N-acetylcysteine for the treatment of idiopathic pulmonary fibrosis: A systematic review and meta-analysis.
The prevalence of idiopathic pulmonary fibrosis (IPF) is increasing every year. Pirfenidone and nintedanib were approved for treatment of IPF in 2014, but they received only a conditional recommendation for use and, thus, to date no drugs are strongly recommended for IPF. The aim of this study was to assess the effectiveness and safety of the currently approved drugs for IPF and N-acetylcysteine (NAC), the most debated drug in the last update of guidelines for IPF treatment. ⋯ The rank of effectiveness emerging from this meta-analysis represents an indirect indicator of potential differences between currently approved doses of pirfenidone and nintedanib. Direct comparisons are necessary to assess this matter, and well designed bench-to-bedside studies would permit to understand the potential of combined, sequential, or adjunctive treatment regimens in which perhaps NAC may have a role for specific clusters of IPF patients.
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Pulm Pharmacol Ther · Oct 2016
Randomized Controlled TrialAntitussive effect of carcainium chloride in patients with chronic cough and idiopathic interstitial pneumonias: A pilot study.
Cough is a common presenting symptom in patients with idiopathic interstitial pneumonia (IIP); it is often disabling, and lacks effective treatment. Studies in animals suggest that carcainium chloride, a quaternary derivative of the local anesthetic lidocaine, is able to inhibit experimentally induced cough by a mechanism of action distinct from that of lidocaine. ⋯ The results of this exploratory study indicate that nebulised VRP700 improved cough and quality of life in hospitalised IIP patients with no significant side effects. A larger trial is warranted to assess these promising results.
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Pulm Pharmacol Ther · Oct 2016
Randomized Controlled TrialEfficacy of tranexamic acid in haemoptysis: A randomized, controlled pilot study.
Haemoptysis is a life threatening condition irrespective of aetiology. Tranexamic acid (TA), a potent anti-fibrinolytic agent, has been shown to control bleeding, decrease transfusion requirement in knee & hip arthroplasty, coronary artery bypass grafting and heavy menstrual bleeding. TA also has mortality benefit in bleeding from surgical and trauma patients. But the studies, regarding efficacy and safety of TA in controlling haemoptysis are conflicting. ⋯ TA decreases severity of haemoptysis and can be used as a bridging therapy in acute haemoptysis before definitive intervention can be under taken.