Expert opinion on pharmacotherapy
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Expert Opin Pharmacother · Apr 2007
Review Comparative StudyThe use of levosimendan in comparison and in combination with dobutamine in the treatment of decompensated heart failure.
Levosimendan is a new calcium sensitizer with inotropic and vasodilatory actions mediated by the sensitization of contractile proteins to calcium, opening of potassium channels and inhibition of phosphodiesterase-3. Its alternative mechanisms of action to those of other traditional inotropes provide a new approach in the management of decompensated heart failure. In contrast to dobutamine, levosimendan does not increase myocardial oxygen demand and, therefore, it is thought to have a lower potential to induce increases in myocardial ischemia and cardiac arrhythmias. ⋯ There are more data on the safety of levosimendan in ischemic patients than with any other inotropic drug and, therefore, levosimendan seems to be safe and effective in patients with ischemic heart disease when used at the recommended doses. Despite advances in heart failure therapy, many patients experience clinical deterioration, or do not respond to a single inotropic drug. Increasing evidence suggests the use of levosimendan in combination with dobutamine in patients with decompensated heart failure that is refractory to dobutamine alone.
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Expert Opin Pharmacother · Apr 2007
ReviewInhaled therapy for stable chronic obstructive pulmonary disease.
Bronchodilators (anticholinergic drugs and beta2-agonist drugs) represent the mainstay of chronic obstructive pulmonary disease treatment and can be combined with inhaled corticosteroids for greater efficacy. This review examines the role of short- and long-acting cholinergic drugs, together with that of short- and long-acting beta2-agonist drugs. ⋯ Combination therapy is more frequently used due to its practicality and capacity to enhance compliance. The main studies on treatment combinations are also analyzed in this paper.
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Expert Opin Pharmacother · Apr 2007
ReviewDuodenal levodopa infusion for the treatment of Parkinson's disease.
Motor fluctuations are a common problem in the long-term management of Parkinson's disease (PD), resulting in disability and impaired quality of life. The relatively short serum half-life (approximately 90 min) of oral levodopa/carbidopa and its erratic absorption due to delayed and inconsistent gastric emptying (a non-motor feature of PD) are thought to be important factors in the development of motor fluctuations. Continuous infusion of levodopa/carbidopa directly into the small intestine of PD patients results in marked reduction of motor fluctuations by reducing plasma levodopa variability by an order of magnitude over oral therapy. ⋯ The development of a micronized levodopa (20 mg/ml) and carbidopa (5 mg/ml) suspension utilizing a methylcellulose gel provides the high levodopa concentration and physical and chemical stability necessary for long-term enteral therapy. Clinical evidence indicates that a marked reduction of motor fluctuations and dyskinesias can be achieved and maintained by intraduodenal administration of this suspension. This article reviews the published data describing the efficacy and safety of duodenal levodopa, and discusses its current and potential role in meeting the needs of PD patients.
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Expert Opin Pharmacother · Apr 2007
ReviewSevere community-acquired pneumonia: approach to therapy.
Despite substantial progress in therapeutic options, severe community-acquired pneumonia (CAP) remains a significant cause of morbidity and mortality worldwide. Recognising the clinical importance of CAP over the past several years, different medical societies and health organisations in different countries have proposed specific guidelines for the management of CAP. Early and rapid initiation of antimicrobial therapy has been advocated for a favourable outcome. ⋯ Dual therapy is emerging as the preferred therapy for severe CAP. The regimen is based on an epidemiological approach with emphasis on covering both typical and atypical pathogens. Non-antimicrobial adjuvant therapies including non-invasive ventilation and immunomodulatory agents are emerging as promising area for future development.
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Expert Opin Pharmacother · Apr 2007
Meeting highlights of the European Respiratory Society annual congress 02-06 September 2006, Munich, Germany.
In pulmonary medicine, there are two major international meetings held annually: the annual meeting of the American Thoracic Society (ATS), and that of the European Respiratory Society (ERS). The 2006 ERS Annual Congress was held in Munich, Germany. ⋯ With > 5000 abstracts and ~ 17,000 participants, the 2006 ERS-congress outnumbered even the 2006 ATS meeting. Research areas covered all aspects of pulmonary diseases, although this year (as in previous years) obstructive pulmonary diseases such as COPD (chronic obstructive pulmonary disease) and asthma were clearly the main focus.