Minerva medica
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Vitamin D is a fat-soluble vitamin, which is obtained by conversion of 7-dehydrocholesterol in the skin by UV ray and by diet. Its role on bone mineralization has been known for over two hundred years, while its non-skeletal effects have been acknowledged only in the last few years. ⋯ Vitamin D may improve lung function and response to steroids therapy, reduce airway remodeling and disease exacerbations. The aim of this study is to review the role of Vitamin D in asthma and COPD.
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Lung transplant is a therapeutic option for end stage lung diseases, but only a limited number of lung grafts is considered suitable for transplantation. It has been recently suggested an approach to improve and maximize donor lung suitability, namely ventilation strategies to prevent lung damage and preserve function before transplantation. In potential lung donor patients, the use of lung-protective ventilatory strategies may protect against and at least partially reverse some conditions, such as ventilator-induced lung injury, atelectasis and neurogenic pulmonary edema, resulting in improved donor organ procurement. ⋯ This approach could be further improved by using lung ultrasound (LUS) which demonstrated to be more accurate than bedside chest radiography in detecting and distinguishing different degrees of aeration loss, and could be useful in the evaluation of alveolar recruitment following the application of PEEP or after performing any recruitment maneuver. Finally, the close future is the exploration of ex-vivo reconditioning which introduces the exciting concept of both a protective ventilation and a protective perfusion, reducing the risk of ventilation associated damage, and, on the other hand, washing out potential inflammatory cytokines by low volume high oncotic pressure perfusion, managing the risk of edema by capillary leakage. Addressing these challenges will allow more patients with end-stage lung disease access to a lung transplant.
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Chronic obstructive pulmonary disease (COPD) is the third leading cause of mortality worldwide. Clinical features of the disease include exertional dyspnea and chronic cough, while persistent airflow obstruction detected at spirometry is the defining element of the disease. ⋯ The recent GeneCOPD study suggested that a proportion of this population might present significant radiological features of respiratory disease. This commentary article focuses on the possible future role of chest imaging, including ultrasound of the respiratory muscles, integrated with additional functional tests, such as body plethysmography and diffusing capacity for carbon monoxide of the lungs (DLCO), in a multidimensional assessment of COPD.