scholarly journals Opioids for breathlessness: Psychological and neural factors influencing response variability

2018 ◽  
Author(s):  
Sara J. Abdallah ◽  
Olivia K. Faull ◽  
Vishvarani Wanigasekera ◽  
Sarah L. Finnegan ◽  
Dennis Jensen ◽  
...  
Keyword(s):  
Negative Affect ◽  
Healthy Volunteers ◽  
Brain Activity ◽  
Imaging Study ◽  
Hierarchical Cluster ◽  
Opioid Therapy ◽  
Anterior Cingulate ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Opioid Efficacy

ABSTRACTEffective management of distressing bodily symptoms (such as pain and breathlessness) is an important clinical goal. However, extensive variability exists in both symptom perception and treatment response. One theory for understanding variability in bodily perception is the ‘Bayesian Brian Hypothesis’, whereby symptoms may result from the combination of sensory inputs and prior expectations. In light of this theory, we explored the relationships between opioid responsiveness, behavioural/physiological symptom modulators and brain activity during anticipation of breathlessness.MethodsWe utilised two existing opioid datasets to investigate the relationship between opioid efficacy and physiological/behavioural qualities, employing hierarchical cluster analyses in: 1) a clinical study in chronic obstructive pulmonary disease, and 2) a functional magnetic resonance brain imaging study of breathlessness in healthy volunteers. We also investigated how opioid efficacy relates to anticipatory brain activity using linear regression in the healthy volunteers.ResultsConsistent across both datasets, diminished opioid efficacy was more closely associated with negative affect than with other physiological and behavioural properties. Furthermore, in healthy individuals, brain activity in the anterior cingulate and ventromedial prefrontal cortices during anticipation of breathlessness were inversely correlated with opioid effectiveness.ConclusionDiminished opioid efficacy for relief of breathlessness may be associated with high negative affective qualities, and was correlated with the magnitude of brain activity during anticipation of breathlessness.Clinical implicationsNegative affect and symptom expectations may influence perceptual systems to become less responsive to opioid therapy.

scholarly journals Treating the lungs via the brain: Mechanisms underpinning improvements in breathlessness with pulmonary rehabilitation

2017 ◽  
Author(s):  
Mari Herigstad ◽  
Olivia Faull ◽  
Anja Hayen ◽  
Eleanor Evans ◽  
Maxine F. Hardinge ◽  
...  
Keyword(s):  
Pulmonary Rehabilitation ◽  
Brain Activity ◽  
Anterior Cingulate ◽  
Chronic Obstructive ◽  
Related Activity ◽  
Attention Regulation ◽  
Obstructive Pulmonary Disease ◽  
Psychological Measures ◽  
Neural Representations ◽  
Neural Processes

ABSTRACTBackgroundBreathlessness in chronic obstructive pulmonary disease (COPD) is often discordant with airway pathophysiology (“over-perception”). Pulmonary rehabilitation has profound effects upon breathlessness, without influencing lung function. Learned associations can influence brain mechanisms of sensory perception. We therefore hypothesised that improvements in breathlessness with pulmonary rehabilitation may be explained by changing neural representations of learned associations, reducing “over-perception”.MethodsIn 31 patients with COPD, we tested how pulmonary rehabilitation altered the relationship between brain activity during learned associations with a word-cue task (using functional magnetic resonance imaging), clinical, and psychological measures of breathlessness.ResultsImprovements in breathlessness and breathlessness-anxiety correlated with reductions in word-cue related activity in the insula and anterior cingulate cortex (ACC) (breathlessness), and increased activations in attention regulation and motor networks (breathlessness-anxiety). Greater baseline (pre-rehabilitation) activity in the insula, ACC and prefrontal cortex correlated with the magnitude of improvement in breathlessness and breathlessness anxiety.ConclusionsPulmonary rehabilitation reduces the influence of learned associations upon neural processes that generate breathlessness. Patients with stronger word-cue related activity at baseline benefitted more from pulmonary rehabilitation. These findings highlight the importance of targeting learned associations within treatments for COPD, demonstrating how neuroimaging may contribute to patient stratification and more successful personalised therapy.

A generic fluticasone propionate and salmeterol dry powder inhaler: Evidence of usability, function, and robustness

2021 ◽  
Vol 42 (1) ◽  
pp. 30-35 ◽  
Author(s):  
Donald P. Tashkin ◽  
Arkady Koltun ◽  
Róisín Wallace
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Fluticasone Propionate ◽  
Healthy Volunteers ◽  
Pulmonary Disease ◽  
Dry Powder Inhaler ◽  
Chemical Degradation ◽  
Chronic Obstructive ◽  
Dry Powder ◽  
Obstructive Pulmonary Disease ◽  
Flow Rates

Background: A generic combination of fluticasone propionate and salmeterol xinafoate inhalation powder in a premetered, multidose, nonreusable inhaler was recently approved. Objective: To assess the performance of the generic device. Methods: Findings from three studies with regard to device usability, function, and robustness were reviewed. Results: In a study to assess device function in patients and healthy volunteers, the generic device was successfully used by patients with asthma and chronic obstructive pulmonary disease who were either dry powder inhaler users or dry powder inhaler‐naive, even though they were not trained beyond being provided the instructions for use. In a study to measure inhaled flow rates generated by patients and healthy volunteers, the generic device consistently simulated the delivery of a full dose of drug, even to patients with severe respiratory disease and reduced inspiratory flow rates. Although the generic device had a slightly higher airflow resistance, this study demonstrated that this difference did not result in any clinically meaningful differences in terms of drug delivery. Pressure drop, a key parameter that drives the fluidization and aerosolization of the powder dose, was found to be comparable between the devices. In an open-label study, the generic device met all U.S. Food and Drug Administration specifications for device robustness after 21.5 days of twice-daily dosing via oral inhalation among 111 participants with asthma or chronic obstructive pulmonary disease. All inhalers tested demonstrated conformity with a pharmacopeia with respect to key quality parameters (assay, delivered dose uniformity, aerodynamic size distribution). There was no evidence of chemical degradation of the active ingredients, nor of microbial or water ingress into the powder, as a result of inhaler use.

scholarly journals Predictors of chronic opioid therapy in Medicaid beneficiaries with HIV who initiated antiretroviral therapy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
GYeon Oh ◽  
Emily S. Brouwer ◽  
Erin L. Abner ◽  
David W. Fardo ◽  
Patricia R. Freeman ◽  
...  
Keyword(s):  
Regression Models ◽  
Opioid Therapy ◽  
Chronic Obstructive ◽  
Chronic Opioid Therapy ◽  
Hepatitis C Infection ◽  
Antipsychotic Therapy ◽  
Obstructive Pulmonary Disease ◽  
Logistic Regression Models ◽  
Factors Associated ◽  
Medicaid Beneficiaries

AbstractThe factors associated with chronic opioid therapy (COT) in patients with HIV is understudied. Using Medicaid data (2002–2009), this retrospective cohort study examines COT in beneficiaries with HIV who initiated standard combination anti-retroviral therapy (cART). We used generalized estimating equations on logistic regression models with backward selection to identify significant predictors of COT initiation. COT was initiated among 1014 out of 9615 beneficiaries with HIV (male: 10.4%; female: 10.7%). Those with older age, any malignancy, Hepatitis C infection, back pain, arthritis, neuropathy pain, substance use disorder, polypharmacy, (use of) benzodiazepines, gabapentinoids, antidepressants, and prior opioid therapies were positively associated with COT. In sex-stratified analyses, multiple predictors were shared between male and female beneficiaries; however, chronic obstructive pulmonary disease, liver disease, any malignancy, and antipsychotic therapy were unique to female beneficiaries. Comorbidities and polypharmacy were important predictors of COT in Medicaid beneficiaries with HIV who initiated cART.

Abstract WMP117: Regional Homogeneity Changes In Patients With Transient Ischemic Attack: A Resting-state Functional Magnetic Resonance Imaging Study

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Jian Guo ◽  
Ning Chen ◽  
Muke Zhou ◽  
Pian Wang ◽  
Li He
Keyword(s):  
Transient Ischemic Attack ◽  
Neural Activity ◽  
Resting State ◽  
Right Hemisphere ◽  
Brain Activity ◽  
Imaging Study ◽  
Brain Regions ◽  
Regional Homogeneity ◽  
Anterior Cingulate ◽  
Ischemic Attack

Background: Transient ischemic attack (TIA) can increase the risk of some neurologic dysfunctions, of which the mechanism remains unclear. Resting-state functional MRI (rfMRI) is suggested to be a valuable tool to study the relation between spontaneous brain activity and behavioral performance. However, little is known about whether the local synchronization of spontaneous neural activity is altered in TIA patients. The purpose of this study is to detect differences in regional spontaneous activities throughout the whole brain between TIAs and normal controls. Methods: Twenty one TIA patients suffered an ischemic event in the right hemisphere and 21 healthy volunteers were enrolled in the study. All subjects were investigated using cognitive tests and rfMRI. The regional homogeneity (ReHo) was calculate and compared between two groups. Then a correlation analysis was performed to explore the relationship between ReHo values of brain regions showing abnormal resting-state properties and clinical variables in TIA group. Results: Compared with controls, TIA patients exhibited decreased ReHo in right dorsolateral prefrontal cortex (DLPFC), right inferior prefrontal gyrus, right ventral anterior cingulate cortex and right dorsal posterior cingular cortex. Moreover, the mean ReHo in right DLPFC and right inferior prefrontal gyrus were significantly correlated with MoCA in TIA patients. Conclusions: Neural activity in the resting state is changed in patients with TIA. The positive correlation between regional homogeneity of rfMRI and cognition suggests that ReHo may be a promising tool to better our understanding of the neurobiological consequences of TIA.

scholarly journals Effects of Single Nucleotide Polymorphisms 869 T/C in the Exon 1 Locus of Transforming Growth Factor-β1 Gene on Susceptibility and Airflow Restriction of Chronic Obstructive Pulmonary Disease

2021 ◽  
Author(s):  
Jie Liu ◽  
Wenjing Zhu
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Single Nucleotide Polymorphisms ◽  
Healthy Volunteers ◽  
Chronic Obstructive ◽  
Nucleotide Polymorphisms ◽  
Single Nucleotide ◽  
Obstructive Pulmonary Disease ◽  
Genotype Frequencies ◽  
Copd Patients ◽  
Tgf Β1

Abstract Background: Chronic obstructive pulmonary disease (COPD) is the most common chronic respiratory disease which is expected to become the third leading cause of death worldwide in 2030. Series of susceptibility genes and single nucleotide polymorphism (SNPs) play an important role in the occurrence and development of COPD.Methods: In our study, 98 COPD patients and 90 healthy volunteers were enrolled. The +869 SNP (SNP, Single Nucleotide Polymorphisms) of TGF-β1 was detected in 98 COPD patients and 90 healthy volunteers by PCR-DNA sequencing. The effects of different genotypes of +869 locus on the susceptibility of COPD, pulmonary function and airflow limitation of COPD patients were analyzed.Results: Allele C of +869 locus was associated with the susceptibility of COPD (OR:1.913, 95% CI: 1.251-2.926). The predicted value of FEV1% (FEV1, Forced Expiratory Volume in One Second) in patients with CC of +869 locus was significantly lower than that in patients with TT (P < 0.05). The genotype frequencies of CC, CT and TT were 6.5%, 58.7% and 34.8% in Mild-to-Moderate airflow restriction patients. In severe airflow restriction patients, the genotype frequencies were CC 23.1%, CT 57.7% and TT 19.2%. The distribution of CC genotype in severe airflow restriction COPD patients was significantly higher than that in Mild-to-Moderate airflow restriction COPD patients (P = 0.037). Moreover, the frequency of C allele was significantly higher in patients with severe airflow restriction than that patients with Mild-to-Moderate airflow restriction (P = 0.024).Conclusions: The SNP of +869 T/C in TGF-β1 is closely related to the susceptibility of COPD and the airflow restriction of COPD patients.

Sign in / Sign up

Export Citation Format

Share Document