scholarly journals Clinical variability of respiratory pulmonary hypertension: implications for diagnosis and management

2013 ◽  
Vol 8 ◽  
Author(s):  
Lucio Casali ◽  
Pierluigi Carratù ◽  
Matteo Sofia
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Fibrosis ◽  
Pulmonary Disease ◽  
Respiratory Diseases ◽  
Randomized Clinical Trials ◽  
Chronic Obstructive ◽  
Clinical Classification ◽  
Obstructive Pulmonary Disease ◽  
Chronic Respiratory Diseases ◽  
Obstructive Sleep

Pulmonary Hypertension (PH) associated to chronic respiratory diseases is currently classified in the 3rd group, as a mild to moderate form of pre-capillary PH that progressively complicates the prognosis of associated pulmonary disease. In clinical practice, however, some unresolved issues in the respiratory PH should be considered: 1) the PH heterogeneity in some respiratory diseases, such as Chronic Obstructive Pulmonary Disease (COPD), where the prevalence of unrecognized left heart disease, or chronic pulmonary thromboembolism may change the clinical classification; 2) the combining form of severe PH which often is not correlated to chronic ventilator impairment, while outcome is strictly related to pulmonary haemodynamics. The recognition of out of proportion respiratory PH in several chronic respiratory diseases which include COPD, Idiopathic Pulmonary Fibrosis (IPF), Combined Pulmonary Fibrosis and Emphysema, Obstructive Sleep Apnea (OSA), Obesity Hypoventilation Syndrome (OHS) may be important for a comprehensive clinical classification of severe respiratory PH, as well as, for the inclusion of these patients in randomized clinical trials on PH targeted therapy.

scholarly journals Tanimilast, A Novel Inhaled Pde4 Inhibitor for the Treatment of Asthma and Chronic Obstructive Pulmonary Disease

2021 ◽  
Vol 12 ◽  
Author(s):  
Fabrizio Facchinetti ◽  
Maurizio Civelli ◽  
Dave Singh ◽  
Alberto Papi ◽  
Aida Emirova ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Side Effects ◽  
Pulmonary Disease ◽  
Respiratory Diseases ◽  
Pde4 Inhibitor ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Chronic Respiratory Diseases ◽  
Copd Patients ◽  
Anti Inflammatory

Chronic respiratory diseases are the third leading cause of death, behind cardiovascular diseases and cancer, affecting approximately 550 million of people all over the world. Most of the chronic respiratory diseases are attributable to asthma and chronic obstructive pulmonary disease (COPD) with this latter being the major cause of deaths. Despite differences in etiology and symptoms, a common feature of asthma and COPD is an underlying degree of airways inflammation. The nature and severity of this inflammation might differ between and within different respiratory conditions and pharmacological anti-inflammatory treatments are unlikely to be effective in all patients. A precision medicine approach is needed to selectively target patients to increase the chance of therapeutic success. Inhibitors of the phosphodiesterase 4 (PDE4) enzyme like the oral PDE4 inhibitor roflumilast have shown a potential to reduce inflammatory-mediated processes and the frequency of exacerbations in certain groups of COPD patients with a chronic bronchitis phenotype. However, roflumilast use is dampened by class related side effects as nausea, diarrhea, weight loss and abdominal pain, resulting in both substantial treatment discontinuation in clinical practice and withdrawal from clinical trials. This has prompted the search for PDE4 inhibitors to be given by inhalation to reduce the systemic exposure (and thus optimize the systemic safety) and maximize the therapeutic effect in the lung. Tanimilast (international non-proprietary name of CHF6001) is a novel highly potent and selective inhaled PDE4 inhibitor with proven anti-inflammatory properties in various inflammatory cells, including leukocytes derived from asthma and COPD patients, as well as in experimental rodent models of pulmonary inflammation. Inhaled tanimilast has reached phase III clinical development by showing promising pharmacodynamic results associated with a good tolerability and safety profile, with no evidence of PDE4 inhibitors class-related side effects. In this review we will discuss the main outcomes of preclinical and clinical studies conducted during tanimilast development, with particular emphasis on the characterization of the pharmacodynamic profile that led to the identification of target populations with increased therapeutic potential in inflammatory respiratory diseases.

scholarly journals Pulmonary Hypertension and Chronic Obstructive Pulmonary Disease: When Is It Out of Proportion?

2013 ◽  
Vol 12 (3) ◽  
pp. 122-126
Author(s):  
Sonja Bartolome
Keyword(s):  
Heart Failure ◽  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Hypertension ◽  
Pulmonary Disease ◽  
Diastolic Heart Failure ◽  
Hypoxic Pulmonary Vasoconstriction ◽  
Systolic Heart Failure ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Obstructive Sleep

Patients with chronic obstructive pulmonary disease (COPD) often present with mild pulmonary hypertension (PH). This finding has been attributed to hypoxic pulmonary vasoconstriction. However, a small proportion of COPD patients will present with moderate or severe elevations in their pulmonary artery pressure (PAP), and these patients appear to have worsened symptoms and survival when compared to patients with milder elevations in PAP. The diagnosis of PH in COPD may be difficult, due to inaccuracies in the echocardiographic estimates of PAP in these patients. Additionally, many patients with COPD will also have comorbid conditions such as diastolic heart failure, systolic heart failure, or obstructive sleep apnea, which may cause increased pulmonary pressures through other mechanisms. Clinical trials investigating the effect of PH-specific therapy for patients with PH and COPD have been small, with mixed results. A careful evaluation for other causes of PH and hemodynamic evaluation will help guide medical therapy for this group of patients.

Pulmonary rehabilitation in chronic lung disease and heart failure

ESC CardioMed ◽  
2018 ◽  
pp. 1055-1058
Author(s):  
William D.-C. Man ◽  
Rachael A. Evans
Keyword(s):  
Heart Failure ◽  
Chronic Obstructive Pulmonary Disease ◽  
Chronic Heart Failure ◽  
Pulmonary Disease ◽  
Pulmonary Rehabilitation ◽  
Respiratory Diseases ◽  
Evidence Base ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Chronic Respiratory Diseases

Over the past two decades, a growing evidence base has emerged to support the benefits of pulmonary rehabilitation. It is now firmly established as a cornerstone of management in chronic obstructive pulmonary disease and other chronic respiratory diseases. This chapter describes the evidence base supporting the use of pulmonary rehabilitation, and the typical content of a pulmonary rehabilitation programme. As cardiovascular and respiratory diseases commonly exist, the effects and influence of cardiovascular disease on pulmonary rehabilitation are discussed. Finally, as there is growing interest to explore joint breathlessness rehabilitation services due to the symptomatic and functional similarities between chronic heart failure and chronic obstructive pulmonary disease, early work exploring the effects of pulmonary rehabilitation in chronic heart failure is described.

Oral and nasal probiotic administration for the prevention and alleviation of allergic diseases, asthma and chronic obstructive pulmonary disease

2020 ◽  
pp. 1-16 ◽  
Author(s):  
Sadegh Azimzadeh Jamalkandi ◽  
Ali Ahmadi ◽  
Iman Ahrari ◽  
Jafar Salimian ◽  
Mehrdad Karimi ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Respiratory Diseases ◽  
Clinical Symptoms ◽  
Specific Treatment ◽  
Allergic Diseases ◽  
Oral Route ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Chronic Respiratory Diseases

Abstract Interaction between a healthy microbiome and the immune system leads to body homeostasis, as dysbiosis in microbiome content and loss of diversity may result in disease development. Due to the ability of probiotics to help and modify microbiome constitution, probiotics are now widely used for the prevention and treatment of different gastrointestinal, inflammatory, and, more recently, respiratory diseases. In this regard, chronic respiratory diseases including chronic obstructive pulmonary disease (COPD), asthma and allergic rhinitis are among the most common and complicated respiratory diseases with no specific treatment until now. Accordingly, many studies have evaluated the therapeutic efficacy of probiotic administration (mostly via the oral route and much lesser nasal route) on chronic respiratory diseases. We tried to summarise and evaluate these studies to give a perspective of probiotic therapy via both the oral and nasal routes for respiratory infections (in general) and chronic respiratory diseases (specifically). We finally concluded that probiotics might be useful for allergic diseases. For asthmatic patients, probiotics can modulate serum cytokines and IgE and decrease eosinophilia, but with no significant reduction in clinical symptoms. For COPD, only limited studies were found with uncertain clinical efficacy. For intranasal administration, although some studies propose more efficiency than the oral route, more clinical evaluations are warranted.

scholarly journals MicroRNAs as Potential Regulators of Immune Response Networks in Asthma and Chronic Obstructive Pulmonary Disease

2021 ◽  
Vol 11 ◽  
Author(s):  
José A. Cañas ◽  
José M. Rodrigo-Muñoz ◽  
Beatriz Sastre ◽  
Marta Gil-Martinez ◽  
Natalia Redondo ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Immune Response ◽  
Pulmonary Disease ◽  
Regulatory Networks ◽  
Respiratory Diseases ◽  
Diagnosis And Treatment ◽  
Chronic Obstructive ◽  
Mirna Regulation ◽  
Obstructive Pulmonary Disease ◽  
Chronic Respiratory Diseases

Chronic respiratory diseases (CRDs) are an important factor of morbidity and mortality, accounting for approximately 6% of total deaths worldwide. The main CRDs are asthma and chronic obstructive pulmonary disease (COPD). These complex diseases have different triggers including allergens, pollutants, tobacco smoke, and other risk factors. It is important to highlight that although CRDs are incurable, various forms of treatment improve shortness of breath and quality of life. The search for tools that can ensure accurate diagnosis and treatment is crucial. MicroRNAs (miRNAs) are small non-coding RNAs and have been described as promising diagnostic and therapeutic biomarkers for CRDs. They are implicated in multiple processes of asthma and COPD, regulating pathways associated with inflammation, thereby showing that miRNAs are critical regulators of the immune response. Indeed, miRNAs have been found to be deregulated in several biofluids (sputum, bronchoalveolar lavage, and serum) and in both structural lung and immune cells of patients in comparison to healthy subjects, showing their potential role as biomarkers. Also, miRNAs play a part in the development or termination of histopathological changes and comorbidities, revealing the complexity of miRNA regulation and opening up new treatment possibilities. Finally, miRNAs have been proposed as prognostic tools in response to both conventional and biologic treatments for asthma or COPD, and miRNA-based treatment has emerged as a potential approach for clinical intervention in these respiratory diseases; however, this field is still in development. The present review applies a systems biology approach to the understanding of miRNA regulatory networks in asthma and COPD, summarizing their roles in pathophysiology, diagnosis, and treatment.

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