308 research outputs found
A Rounded Approach to the Management and Treatment of Obstructive Lung Diseases
Full text linkObstructive lung diseases are characterized by obstruction to airflow, inflamed and easily collapsible airways, and difficulties in exhaling, with a socio-economic burden in terms of medical visits and hospitalizations [...
Obstructive Sleep Apnea:A View from the Back Door
Full text linkObstructive sleep apnea (OSA) is a common disease that may affect up to 50% of the adult population and whose incidence continues to rise, as well as its health and socio-economic burden. OSA is a well-known risk factor for motor vehicles accidents and decline in work performance and it is frequently accompanied by cardiovascular diseases. The aim of this Special Issue is to focus on the characteristics of OSA in special populations which are less frequently investigated. In this regard, seven groups of experts in the field of sleep medicine gave their contribution in the realization of noteworthy manuscripts which will support all physicians in improving their understanding of OSA with the latest knowledge about its epidemiology, pathophysiology and comorbidities in special populations, which will serve as a basis for future research.</p
Therapeutic Potential of Glucagon-like Peptide-1 Receptor Agonists in Obstructive Sleep Apnea Syndrome Management: A Narrative Review
Full text link: Background: Obstructive Sleep Apnea (OSA) is a prevalent disorder characterized by repetitive upper airway obstructions during sleep, leading to intermittent hypoxia and sleep fragmentation. Current treatments, particularly Continuous Positive Airway Pressure (CPAP), face adherence challenges, necessitating novel therapeutic approaches. Methods: This review explores the potential of Glucagon-like Peptide-1 receptor agonists (GLP-1RA), commonly used for type 2 diabetes and obesity, in managing OSA. GLP-1RA promotes weight loss, enhances insulin sensitivity, and exhibits anti-inflammatory and neuroprotective properties, potentially addressing key pathophysiological aspects of OSA. Results: Emerging evidence suggests that these agents may reduce OSA severity by decreasing upper airway fat deposition and improving respiratory control. Clinical trials have demonstrated significant reductions in the Apnea-Hypopnea Index (AHI) and improvements in sleep quality with GLP-1 therapy. Conclusions: Future research should focus on elucidating the mechanisms underlying GLP-1 effects on OSAS, optimizing combination therapies, and identifying patient subgroups that may benefit the most. Integrating GLP-1RA into OSAS management could revolutionize treatment by addressing both the metabolic and respiratory components of the disorder, ultimately enhancing patient outcomes
Hypercapnia in COPD:Causes, Consequences, and Therapy
Full text linkChronic obstructive pulmonary disease (COPD) is a progressive respiratory disorder that may lead to gas exchange abnormalities, including hypercapnia. Chronic hypercapnia is an independent risk factor of mortality in COPD, leading to epithelial dysfunction and impaired lung immunity. Moreover, chronic hypercapnia affects the cardiovascular physiology, increases the risk of cardiovascular morbidity and mortality, and promotes muscle wasting and musculoskeletal abnormalities. Noninvasive ventilation is a widely used technique to remove carbon dioxide, and several studies have investigated its role in COPD. In the present review, we aim to summarize the causes and effects of chronic hypercapnia in COPD. Furthermore, we discuss the use of domiciliary noninvasive ventilation as a treatment option for hypercapnia while highlighting the controversies within the evidence. Finally, we provide some insightful clinical recommendations and draw attention to possible future research areas.</p
Stratospheric Flight: Aeronautics at the Limit
No full textIn this book, Dr. Andras Sobester reviews the science behind high altitude flight. He takes the reader on a journey that begins with the complex physiological questions involved in taking humans into the "death zone." How does the body react to falling ambient pressure? Why is hypoxia (oxygen deficiency associated with low air pressure) so dangerous and why is it so difficult to 'design out' of aircraft, why does it still cause fatalities in the 21st century? What cabin pressures are air passengers and military pilots exposed to and why is the choice of an appropriate range of values such a difficult problem? How do high altitude life support systems work and what happens if they fail? What happens if cabin pressure is lost suddenly or, even worse, slowly and unnoticed? The second part of the book tackles the aeronautical problems of flying in the upper atmosphere. What loads does stratospheric flight place on pressurized cabins at high altitude and why are these difficult to predict? What determines the maximum altitude an aircraft can climb to? What is the 'coffin corner' and how can it be avoided? The history of aviation has seen a handful of airplanes reach altitudes in excess of 70,000 feet - what are the extreme engineering challenges of climbing into the upper stratosphere? Flying high makes very high speeds possible -- what are the practical limits? The key advantage of stratospheric flight is that the aircraft will be 'above the weather' - but is this always the case? Part three of the book investigates the extreme atmospheric conditions that may be encountered in the upper atmosphere. How high can a storm cell reach and what is it like to fly into one? How frequent is high altitude 'clear air' turbulence, what causes it and what are its effects on aircraft? The stratosphere can be extremely cold - how cold does it have to be before flight becomes unsafe? What happens when an aircraft encounters volcanic ash at high altitude? Very high winds can be encountered at the lower boundary of the stratosphere - what effect do they have on aviation? Finally, part four looks at the extreme limits of stratospheric flight. How high will a winged aircraft will ever be able to fly? What are the ultimate altitude limits of ballooning? What is the greatest altitude that you could still bail out from? And finally, what are the challenges of exploring the stratospheres of other planets and moons? The author discusses these and many other questions, the known knowns, the known unkonwns and the potential unknown unknowns of stratospheric flight through a series of notable moments of the recent history of mankind's forays into the upper atmospheres, each of these incidents, accidents or great triumphs illustrating a key aspect of what makes stratospheric flight aeronautics at the limit
Methodological Aspects of Induced Sputum
Full text linkHighlights What are the main findings? Induced sputum is a valuable non-invasive and cost-effective method for obtaining lower airway secretions, especially in patients who cannot produce sputum naturally. Despite some technical demands and limitations, induced sputum offers significant advantages as a preferred alternative for large-scale and repeated airway sampling in respiratory conditions like asthma and COPD. What is the implication of the main finding? The use of induced sputum provides researchers and clinicians with valuable insights into the cellular and biochemical components of airway secretions, allowing for a better understanding of airway inflammation, immune responses, and treatment efficacy in several respiratory conditions. This allows for large-scale and repeated airway sampling, enabling researchers and clinicians to conduct comprehensive studies and monitor treatment responses over time, ultimately contributing to better patient care and improved outcomes.Highlights What are the main findings? Induced sputum is a valuable non-invasive and cost-effective method for obtaining lower airway secretions, especially in patients who cannot produce sputum naturally. Despite some technical demands and limitations, induced sputum offers significant advantages as a preferred alternative for large-scale and repeated airway sampling in respiratory conditions like asthma and COPD. What is the implication of the main finding? The use of induced sputum provides researchers and clinicians with valuable insights into the cellular and biochemical components of airway secretions, allowing for a better understanding of airway inflammation, immune responses, and treatment efficacy in several respiratory conditions. This allows for large-scale and repeated airway sampling, enabling researchers and clinicians to conduct comprehensive studies and monitor treatment responses over time, ultimately contributing to better patient care and improved outcomes.Abstract We aimed to conduct a state-of-the-art review of the current literature and offer further insights into the methodological aspects concerning induced sputum. The increasing popularity of sputum induction as a non-invasive and cost-effective method for obtaining lower airway secretions from patients who cannot produce sputum naturally has led to extensive research and applications in respiratory conditions like asthma and COPD. This technique allows for analysis of the cellular and biochemical components of the sputum to take place, providing insights into airway inflammation, immune cells, and help in predicting treatment response. Furthermore, induced sputum enables various analyses, including microRNA and gene expression studies and immunophenotyping. The procedure is generally safe and well tolerated, even in patients with airflow limitations; however, monitoring lung function is essential, especially in those with airway hyperresponsiveness. Optimal saline solution concentration and inhalation duration have been investigated, recommending a 15-20 min induction with hypertonic saline. Expectoration involves coughing at the end of each inhalation time. Careful handling during sputum processing is necessary for obtaining accurate results in cell cytology, immunocytochemistry, and in situ hybridization. Overall, induced sputum offers significant advantages as a preferred alternative for large-scale and repeated airway sampling, despite some technical demands and limitations
LABA/LAMA Fixed Dose Combination in Chronic Obstructive Pulmonary Disease: The Impact on Health-Related Quality of Life
No full textBackground: While fixed dose combinations (FDCs) of long-acting beta 2-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) are increasingly tested on their efficacy in improving lung function, their effectiveness on Patient Reported Outcomes (PROs) such as Health Related Quality of Life (HRQoL) and Health Status (HS) deserve more attention. Objectives: To review current available evidence about the treatment effect of fixed LABA/LAMA FDCs on HRQoL. Methods: A systematic literature search for randomized controlled trials (RCTs) about the impact of LABA/LAMA FDCs versus placebo, LABA or LAMA or LABA/ICS on HRQoL in Chronic obstructive pulmonary disease (COPD) patients has been performed. Results: Twenty-eight RCTs (n = 32, 165 COPD patients) investigating the impact of fixed LABA/LAMA combinations on HRQoL were included. Using the St George’ s Respiratory Questionnaire, 27 out of 28 trials assessed HRQoL. LABA/LAMA FDCs significantly improved HRQoL versus placebo in 9 out of 11 trials, while change when compared to other LABA or LAMA monocomponents was significantly better in 11 out 24. In 5 out of 6 RCTs having LABA/ICS as comparators, LABA/LAMA FDC had a similar effect and only 1 showed significant improvement in HRQL compared to LABA/ICS FDC. Conclusion: LABA/LAMA FDCs may be helpful in improving HRQoL, but because of the heterogeneity of performed trials, strong conclusions cannot be drawn. Moreover, due to the different molecule properties, treatment schedule, and device characteristics of each FDC, a generalized judgment seems inappropriate. Pragmatic trials powered to detect real-life differences in HRQoL and head-to-head comparison are needed to guide clinical practice in terms of PROs
Obstructive Sleep Apnea
Full text linkObstructive sleep apnea (OSA) is a common disease that may affect up to 50% of the adult population and whose incidence, as well as its health and socio-economic burden, continues to rise. OSA is a well-known risk factor for motor vehicle accidents and decreased work performance, and it is frequently accompanied by cardiovascular diseases. The aim of this Special Issue is to focus on the characteristics of OSA in special populations that are less frequently investigated. For this purpose, seven groups of experts in the field of sleep medicine contributed noteworthy manuscripts on this subject. The content of these articles, which include the latest knowledge about the epidemiology, pathophysiology and comorbidities of OSA in special populations, will support all physicians who endeavor to improve their understanding of this disease and can serve as a basis for future research
En Route to Personalised Medicine in Obstructive Sleep Apnoea
No full textObstructive sleep apnoea (OSA) is a common disorder that can cause night- and daytime symptoms and impair driving and work performance [...
Exhaled volatile organic compounds for diagnosis and monitoring of asthma
Full text linkThe asthmatic inflammatory process results in the generation of volatile organic compounds (VOCs), which are subsequently secreted by the airways. The study of these elements through gas chromatography-mass spectrometry (GC-MS), which can identify individual molecules with a discriminatory capacity of over 85%, and electronic-Nose (e-NOSE), which is able to perform a quick onboard pattern-recognition analysis of VOCs, has allowed new prospects for non-invasive analysis of the disease in an "omics" approach. In this review, we aim to collect and compare the progress made in VOCs analysis using the two methods and their instrumental characteristics. Studies have described the potential of GC-MS and e-NOSE in a multitude of relevant aspects of the disease in both children and adults, as well as differential diagnosis between asthma and other conditions such as wheezing, cystic fibrosis, COPD, allergic rhinitis and last but not least, the accuracy of these methods compared to other diagnostic tools such as lung function, FeNO and eosinophil count. Due to significant limitations of both methods, it is still necessary to improve and standardize techniques. Currently, e-NOSE appears to be the most promising aid in clinical practice, whereas GC-MS, as the gold standard for the structural analysis of molecules, remains an essential tool in terms of research for further studies on the pathophysiologic pathways of the asthmatic inflammatory process. In conclusion, the study of VOCs through GC-MS and e-NOSE appears to hold promise for the non-invasive diagnosis, assessment, and monitoring of asthma, as well as for further research studies on the disease
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