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Expert Review of Respiratory Medicine Dec 2019: Specific immunotherapy is the only treatment acting on causes and not only on symptoms of respiratory allergy. It was first introduced as subcutaneous immunotherapy... (Review)
Review
: Specific immunotherapy is the only treatment acting on causes and not only on symptoms of respiratory allergy. It was first introduced as subcutaneous immunotherapy (SCIT) with the aim to induce immunological tolerance to the administered allergen(s). In the 1980s, sublingual immunotherapy (SLIT) was developed, mainly to improve the safety, which was a critical issue at that time.: This article reviews the available literature, including a large number of randomized controlled trials, meta-analyses, and real-life studies as well, on the outcomes of SCIT and SLIT concerning the treatment critical issues of the two routes, that are efficacy, safety, cost-effectiveness, and compliance to treatment.: SCIT and SLIT are similarly effective in treating patients with respiratory allergy, providing, based on the induction of typical changes in the immunologic response, an early control of symptoms that steadily increases during the treatment and, once reached the recommended duration of 3 years, continues to work after stopping. This outcome is the major factor influencing the economic advantage of SCIT and SLIT over drug treatment.
Topics: Asthma; Cost-Benefit Analysis; Desensitization, Immunologic; Humans; Patient Compliance; Sublingual Immunotherapy; Treatment Outcome
PubMed: 31581868
DOI: 10.1080/17476348.2019.1676153 -
Lung Aug 2022Few international studies have investigated factors affecting domiciliary non-invasive ventilation (D-NIV) compliance, and data from the UK are limited. We assessed...
Few international studies have investigated factors affecting domiciliary non-invasive ventilation (D-NIV) compliance, and data from the UK are limited. We assessed compliance (defined as ≥ 4 h/night for at least 70% of the time) in a retrospective UK population study, at three time points (0-1 month, 3-4 months and 11-12 months), for all patients commenced on D-NIV over a 5-year period. A total of 359 patients were included. Non-compliant vs. compliant patients were significantly younger (median age 64 (IQR 52-72) vs. 67 (58-75) years, p = 0.032) and more likely to have schizophrenia, consistent at both 3-4 months (5% vs. 1%, p = 0.033) and 11-12 months (5% vs. 2%, p = 0.049). Repeated measures ANOVA demonstrated that the minutes [median (IQR)] of D-NIV used significantly increased at the three time points (0-1 month, 3-4 months and 11-12 months) for patients with hypertension [310 (147.5-431) vs. 341 (89-450) vs. 378 (224.5-477.5), p = 0.003]; diabetes [296.5 (132.5-417.5) vs. 342.5 (94.5-438.5) vs. 382 (247.5-476.25), p = 0.002] and heart failure [293 (177-403) vs. 326 (123-398) vs. 365 (212-493), p = 0.04]. In conclusion, younger and comorbid schizophrenic patients have lower D-NIV compliance rates, and our data suggest that persistence with D-NIV over a year may improve overall use.
Topics: Humans; Middle Aged; Noninvasive Ventilation; Patient Compliance; Respiration, Artificial; Respiratory Insufficiency; Retrospective Studies
PubMed: 35871430
DOI: 10.1007/s00408-022-00557-8 -
Biomechanics and Modeling in... Apr 2022The lung vital function of providing oxygen to the body heavily relies on its mechanical behavior and the interaction with its complex environment. In particular, the...
The lung vital function of providing oxygen to the body heavily relies on its mechanical behavior and the interaction with its complex environment. In particular, the large compliance and the porosity of the pulmonary tissue are critical for lung inflation and air inhalation, and the diaphragm, the pleura, the rib cage and intercostal muscles all play a role in delivering and controlling the breathing driving forces. In this paper, we introduce a novel poromechanical model of the lungs. The constitutive law is derived within a general poromechanics theory via the formulation of lung-specific assumptions, leading to a hyperelastic potential reproducing the volume response of the pulmonary mixture to a change of pressure. Moreover, physiological boundary conditions are formulated to account for the interaction of the lungs with their surroundings, including a following pressure and bilateral frictionless contact. A strategy is established to estimate the unloaded configuration from a given loaded state, with a particular focus on ensuring a positive porosity. Finally, we illustrate through several realistic examples the relevance of our model and its potential clinical applications.
Topics: Diaphragm; Lung; Respiration
PubMed: 35072891
DOI: 10.1007/s10237-021-01547-0 -
Expert Opinion on Therapeutic Patents May 2020: Pulmonary route is one of the preferred routes for the administration of therapeutically active agents for systemic as well as localized delivery. Chronic obstructive... (Review)
Review
: Pulmonary route is one of the preferred routes for the administration of therapeutically active agents for systemic as well as localized delivery. Chronic obstructive pulmonary disease (COPD), bronchial asthma, pneumonia, pulmonary hypertension, bronchiolitis, lung cancer, and tuberculosis are the major chronic diseases associated with the pulmonary system. Knowledge about the affecting factors, namely, the etiology, pathophysiology, and the various barriers (mechanical, chemical, immunological, and behavioral) in pulmonary drug delivery is essential to develop an effective drug delivery system. Formulation strategies and mechanisms of particle deposition in the lungs also play an important role in designing a suitable delivery system.: In the present paper, various drug delivery strategies, viz. nanoparticles, microparticles, liposomes, powders, and microemulsions have been discussed systematically, from a patent perspective.: Patent publications on formulation strategies have been instrumental in the evolution of new techniques and technologies for safe and effective treatment of pulmonary diseases. New delivery systems are required to be simple/reproducible/scalable/cost-effective scale for manufacturing ability and should be safe/effective/stable/controllable for meeting quality and regulatory compliance.
Topics: Administration, Inhalation; Animals; Drug Delivery Systems; Humans; Lung; Lung Diseases; Patents as Topic; Tissue Distribution
PubMed: 32178542
DOI: 10.1080/13543776.2020.1741547 -
Current Opinion in Supportive and... Sep 2020The aim of this review is to discuss the recent literature relating to the involvement of informal carers and peer support in pulmonary rehabilitation. (Review)
Review
PURPOSE OF REVIEW
The aim of this review is to discuss the recent literature relating to the involvement of informal carers and peer support in pulmonary rehabilitation.
RECENT FINDINGS
Informal carers and peer support have been identified by both patients and healthcare workers as a crucial component in the care of those with chronic respiratory disease at home. Pulmonary rehabilitation, a cornerstone in the management of patients with breathlessness, is limited in its clinical effectiveness by poor referral, uptake and completion rates. Engagement of informal carers and support from peers may help maximize the utilization of pulmonary rehabilitation.
SUMMARY
This review highlights the need for more good-quality randomized controlled trials in identifying suitable interventions that may increase uptake and completion of pulmonary rehabilitation programmes. Qualitative studies have highlighted the potential for informal carers and peer support to play a key role in the design of research programmes, and in the delivery of pulmonary rehabilitation. This needs to be addressed in future research.
Topics: Caregivers; Dyspnea; Humans; Patient Compliance; Quality of Life; Referral and Consultation; Respiration Disorders; Social Support
PubMed: 32740276
DOI: 10.1097/SPC.0000000000000517 -
Seminars in Pediatric Surgery Aug 2023ECMO for neonatal and pediatric respiratory failure provides gas exchange to allow lung recovery from reversible pulmonary ailments. This is a comprehensive discussion...
ECMO for neonatal and pediatric respiratory failure provides gas exchange to allow lung recovery from reversible pulmonary ailments. This is a comprehensive discussion on the various strategies and advances utilized by pediatric ECLS specialists today. ECMO patients require continual monitoring, serial gasses and radiographs, near-infrared spectroscopy (NIRS - to monitor oxygen delivery to regional tissue beds), and more quality ECLS directed care. As the foundation to lung recovery, good EMCO closely monitors ECLS flow rates, sweep gasses, and membrane lung function. Mixed venous oxygen saturation (Sv0) greater than 65% indicates good oxygen delivery and sweep gas adjustments maintain PaCO2 of 40-45 mm Hg. Lung recovery ventilatory settings do not fully rest the lungs but maintain normal or nontoxic pressure and oxygen levels. Neonatal recovery settings are PIP (cm H0) of 15-20, PEEP of 5-10, ventilator rate of 12-20 and an inspiratory time of 0.5-1 s, and FiO2 of 0.3-0.5. Pediatric recovery settings are PIP (cm H0) < 25, PEEP of 5-15, ventilator rate of 10-20 and an inspiratory time of 0.8-1 s, and FiO2 of <0.5. Some studies demonstrate a higher recovery PEEP level decreases duration of ECMO, but do not demonstrate a mortality difference. Multiple adjunctive therapies such as surfactant, routine pulmonary clearance and respiratory physiotherapy, iNO, prone positioning, bronchoscopy, POCUS, CT imaging, and extubation or "awake ECLS" can significantly affect pulmonary recovery. Patience is necessary as lung recovery may take weeks or even months on the nontoxic settings. On these settings, dynamic recovery will be revealed by improvement in tidal volume, minute ventilation and radiographic pulmonary aeration, prompting discussion about weaning. When this pulmonary compliance recovery becomes evident, decreasing ECLS flow while also decreasing circuit FiO2 and/or sweep gas are common components to ECMO weaning strategies.
Topics: Infant, Newborn; Humans; Child; Extracorporeal Membrane Oxygenation; Ventilator Weaning; Lung; Respiratory Insufficiency; Oxygen; Respiration, Artificial
PubMed: 37866170
DOI: 10.1016/j.sempedsurg.2023.151329 -
Expert Opinion on Drug Delivery Mar 2023Drugs delivered via the lungs are predominantly used to treat various respiratory disorders, including asthma, chronic obstructive pulmonary diseases, respiratory tract... (Review)
Review
INTRODUCTION
Drugs delivered via the lungs are predominantly used to treat various respiratory disorders, including asthma, chronic obstructive pulmonary diseases, respiratory tract infections and lung cancers, and pulmonary vascular diseases such as pulmonary hypertension. To treat respiratory diseases, targeted, modified or controlled release inhalation formulations are desirable for improved patient compliance and superior therapeutic outcome.
AREAS COVERED
This review summarizes the important factors that have an impact on the inhalable modified release formulation approaches with a focus toward various formulation strategies, including dissolution rate-controlled systems, drug complexes, site-specific delivery, drug-polymer conjugates, and drug-polymer matrix systems, lipid matrix particles, nanosystems, and formulations that can bypass clearance via mucociliary system and alveolar macrophages.
EXPERT OPINION
Inhaled modified release formulations can potentially reduce dosing frequency by extending drug's residence time in the lungs. However, inhalable modified or controlled release drug delivery systems remain unexplored and underdeveloped from the commercialization perspective. This review paper addresses the current state-of-the-art of inhaled controlled release formulations, elaborates on the avenues for developing newer technologies for formulating various drugs with tailored release profiles after inhalational delivery and explains the challenges associated with translational feasibility of modified release inhalable formulations.
Topics: Humans; Delayed-Action Preparations; Drug Delivery Systems; Lung; Asthma; Administration, Inhalation; Respiratory Tract Diseases
PubMed: 36720629
DOI: 10.1080/17425247.2023.2175814 -
Translational Research : the Journal of... Jul 2023Dysregulation of type II alveolar epithelial cells (AECII) plays a vital role in the initiation and development of pulmonary fibrosis (PF). Dachshund homolog 1 (Dach1),...
Dysregulation of type II alveolar epithelial cells (AECII) plays a vital role in the initiation and development of pulmonary fibrosis (PF). Dachshund homolog 1 (Dach1), frequently expressed in epithelial cells with stem cell potential, controls cell proliferation, apoptosis, and cell cycle in tissue development and disease process. In this study, we demonstrated that the lungs collected from PF patients and mice of Bleomycin (BLM)-treated were characterized by low expression of Dachshund homolog 1 (Dach1), especially in AECII. Dach1 deficiency in the alveolar epithelium exacerbated PF in BLM-treated mice, as evidenced by reduced pulmonary function and increased expression of fibrosis markers. Rather, treatment with lung-specific overexpression of Dach1 alleviated histopathological damage, lung compliance, and fibrosis in BLM-treated mice. Moreover, overexpression of Dach1 could inhibit epithelial apoptosis in vitro. Conversely, primary AECII with Dach1 depletion were more susceptible to apoptosis in vivo. Mechanically, Dach1 combined with C-Jun protooncogene selectively bound to the promoter of B-cell lymphoma 2 interacting mediators of cell death (Bim), by which it repressed Bim expression and alleviated epithelial apoptosis. Taken together, our data support that Dach1 in AECII contributes to the progression of PF and may be a viable target for the prevention and treatment of PF.
Topics: Animals; Mice; Alveolar Epithelial Cells; Apoptosis; Bleomycin; Epithelium; Eye Proteins; Lung; Pulmonary Fibrosis
PubMed: 36754276
DOI: 10.1016/j.trsl.2023.01.006 -
European Review For Medical and... Jun 2023We planned to investigate the effect of close monitoring on compliance and the factors affecting compliance among patients receiving positive airway pressure (PAP)... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
We planned to investigate the effect of close monitoring on compliance and the factors affecting compliance among patients receiving positive airway pressure (PAP) treatment due to obstructive sleep apnea (OSA).
PATIENTS AND METHODS
This study was a single-center, prospective, randomized, controlled study. Between January 2022 and May 2022, 192 patients who were 18 years of age or older, had been newly diagnosed with OSA, and underwent PAP titration at our sleep laboratory were included in the study.
RESULTS
One hundred twenty-eight patients were randomized as group 1 (study group) and group 2 (control group). There was no correlation between good continuous positive airway pressure (CPAP) compliance and diabetes mellitus, hypertension, hyperthyroidism, or allergic rhinitis. However, there was a statistically significant correlation between good CPAP compliance and chronic obstructive pulmonary disease (COPD) or asthma.
CONCLUSIONS
Sleeping with such a device will be very difficult and uncomfortable. As observed from previous studies, adherence to CPAP is a critical problem worldwide regardless of geography, education, age, and sex. Telemedicine monitoring may be a good follow-up tool. Nevertheless, the essential tool is interpersonal communication by phone calls, face-to-face computer communication, or frequent visits.
Topics: Humans; Adolescent; Adult; Follow-Up Studies; Prospective Studies; Polysomnography; Sleep Apnea, Obstructive; Sleep; Continuous Positive Airway Pressure; Patient Compliance
PubMed: 37401281
DOI: 10.26355/eurrev_202306_32781 -
Heart & Lung : the Journal of Critical... 2022
Topics: Humans; Patient Compliance; Medication Adherence
PubMed: 36058742
DOI: 10.1016/j.hrtlng.2022.08.009