Nihon rinsho. Japanese journal of clinical medicine
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In the treatment of chronic obstructive pulmonary disease (COPD), bronchodilators such as long acting muscarinic antagonist (LAMA) and long acting β agonist(LABA) play key roles for improving respiratory function and symptoms, and reducing risk of exacerbation. However, inhaled corticosteroid (ICS), a key medicine for bronchial asthma, is limitedly used in COPD treatment. ⋯ Therefore, ICS/LABA or ICS/LAMA should be prescribed to those overlapped patients. Concentration of exhaled nitrogen oxide and percentage of peripheral eosinophil may be good biomarkers for discriminating the COPD patients who have good response to ICS treatment.
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Several non-surgical and minimally invasive bronchoscopic interventions, such as bronchoscopic lung volume reduction (BLVR) techniques, have been developed to treat patients with severe chronic obstructive pulmonary disease (COPD). BLVR has been studied for treatment in severe COPD patients with emphysema. BLVR with one-way endobronchial valves is reported to be effective for patients with a heterogeneous emphysema distribution and without inter-lobar collateral ventilation. ⋯ Targeted lung denervation(TLD) is a novel bronchoscopic intervention based on ablation of parasympathetic nerves surrounding the main bronchi. TLD seems to be effective for COPD with chronic bronchitis phenotype. This review gives a general overview of BLVR with one-way valve and lung volume reduction coil, and TLD.
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Asthma and COPD, once regarded as distinct disease entities, often overlaps especially in the elderly and smokers. GINA/GOLD joint document 2014 has proposed a clinical entity of ACOS (asthma-COPD overlap syndrome) characterized by irreversible airflow limitation with clinical features of both asthma and COPD, although evidences for definite diagnosis and treatment are limited. ACOS includes several different phenotypes such as severe asthma with airway remodeling, incomplete airflow reversibility as a consequence of childhood asthma and smoking, eosinophilic phenotype of COPD, and so on. Considering the therapeutic modalities currently available for asthma and COPD, it is important to identify the patients who respond well to inhaled corticosteroids.