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Risk factors – Treatable traits
Published in Vibeke Backer, Peter G. Gibson, Ian D. Pavord, The Asthmas, 2023
Vibeke Backer, Peter G. Gibson, Ian D. Pavord
Smoking is a chronic dependence disorder with a high relapse rate. It interacts with obstructive airway disease to increase the disease burden. The illness burden from smoking and asthma can be assessed by measuring smoking-related disability-adjusted life years, termed DALYS. The unit, one DALY, represents a measure of overall disease burden and is expressed as the number of years lost due to ill-health, disability or early death. The burden from smoking-related DALYS for asthma is high and is estimated to account for 9.3% of the cumulative 22.8 million DALYS caused by asthma globally.
Cystic Fibrosis and Pancreatic Disease
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Elissa M. Downs, Jillian K. Mai, Sarah Jane Schwarzenberg
The complex management of respiratory disease due to thickened secretions and airway changes causes significant burden of disease. Primary interventions for pulmonary manifestations of CF focus on mitigating obstructive airway disease, including bronchodilators, anti-inflammatory therapies, antibiotics for acute and chronic infection, and airway clearance therapies. Vest therapy (high-frequency chest wall oscillation) is frequently used for airway clearance and is used twice a day for about 30 minutes at a time. Ideally, it is done on an empty stomach or at least an hour after meals to prevent emesis, especially in younger children.
Early Detection of Chronic Obstructive Pulmonary Disease: Influence on Lung Cancer Epidemiology
Published in Ayman El-Baz, Jasjit S. Suri, Lung Imaging and CADx, 2019
Amany F. Elbehairy, Ahmed Sadaka
Skillrud et al. were the first to report an increased incidence of lung cancer in patients with COPD in the 1980s. Including 113 COPD patients and 114 controls (smokers without COPD) matched for age, sex, and smoking history, they reported a fourfold increased risk of lung cancer among patients with airflow obstruction [10]. Since then, this association has been reproduced in many studies while controlling for age and amount of smoke exposure [11-13]. The presence of radiological evidence of emphysema has also been found to be an independent risk factor for the development of lung cancer. Emphysema is associated with a two to three times increased risk of cancer development and even carries a worse prognosis compared with non-emphysematous patients [14-16]. Interestingly, when airflow obstruction and emphysema were included in a single regression model, only emphysema remained as an independent risk factor for lung cancer, suggesting that part of the risk attributed to spirometrically-defined COPD could be due to the presence of emphysema [15]. In this regard, a more recent study comparing the prevalence of lung cancer among current, former, and never smokers found that lung cancer prevalence in smokers (current or former) with emphysema was similar to that found in never smokers with emphysema (2.1% and 2.6%, respectively, p = 0.61) [17]. Thus, the current evidence proves the association between the obstructive airway disease and carcinogenesis. However, this is not a straightforward relationship due to COPD heterogeneity and the presence of multiple disease phenotypes.
A smartphone-based algorithm comprising cough analysis and patient-reported symptoms identifies acute exacerbations of asthma: a prospective, double blind, diagnostic accuracy study
Published in Journal of Asthma, 2023
Paul Porter, Joanna Brisbane, Udantha Abeyratne, Natasha Bear, Scott Claxton
The algorithm tested in this study, which was designed to be used by people with little or no training, provides an objective alternative to patient assessment of symptoms. In current practice, patient-directed Asthma Action Plans have an important role in the early recognition of the disease and guide the patient toward the appropriate time to initiate therapy (28). Compared with patients who have a written Asthma Action Plan, patients without a plan are more likely to be admitted to a hospital and more likely to be admitted on more than one occasion (29). A key component in the deployment of self-management plans is the requirement for a patient to recognize any worsening of their asthma, a task which many might be unable to perform (29–31). The ability of patients to identify deterioration in their respiratory disease is unreliable. Two studies reported that two-thirds of patients with chronic obstructive airway disease could not recognize a worsening of their symptoms (29,31). Our results have confirmed that wheeze is not a reliable indicator of asthma exacerbation, despite being a central component of all asthma action plans.
The pharmacological management of asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS)
Published in Expert Opinion on Pharmacotherapy, 2020
Timothy E. Albertson, James A. Chenoweth, Skyler J. Pearson, Susan Murin
The pharmacotherapy for ACOS patients reflects the mixed pathology of this obstructive airway disease. Use of maintenance and relief therapies are important. Inhaled therapy of long- and short-acting B2AR and MRA agents and ICS is the backbone of the initial treatment. The use of MDI, DPI, NEB or SDM delivery systems are often based on patient and insurance company preference but remains an important variable for medication adherence and proper use. A stepwise approach of adding a LABA to a LAMA and then an ICS is advised after establishing that the ACOS patient’s disease is mediated by Type 2 inflammation. Oral prostaglandin blocking agents are often used next. Systemic corticosteroid use and frequency of exacerbations can be reduced by disease-modifying injectable monoclonal antibodies that are effective in many poorly controlled Type 2 asthma patients and seem to be able to improve some ACOS patients with Type 2 inflammation. Non-Type 2 inflammation patients are likely to benefit from the more traditional COPD exacerbation modifying agents such as roflumilast, NAC, theophylline and/or macrolide antibiotics. A better understanding of the phenotypes and genotypes of ACOS is needed along with more pharmacotherapy studies directed at this important syndrome to improve therapeutic precision.
Clinical characteristics of the BREATHE cohort – a real-life study on patients with asthma and COPD
Published in European Clinical Respiratory Journal, 2020
Vibeke Backer, Ditte K. Klein, Uffe Bodtger, Kerstin Romberg, Celeste Porsbjerg, Jonas S. Erjefält, Karsten Kristiansen, Ruiqi Xu, Alexander Silberbrandt, Laurits Frøssing, Morten Hvidtfeldt, Nicolai Obling, Linnea Jarenbäck, Abir Nasr, Ellen Tufvesson, Michiko Mori, Matilde Winther-Jensen, Lisa Karlsson, Ulf Nihlén, Thomas Veje Flintegaard, Leif Bjermer
This study offered all patients with a similar medical work-up regardless of whether the referral diagnosis was asthma, COPD, or asthma + COPD. For example, all patients completed a range of questionnaires without preselecting them as patients with either asthma and/or COPD, which provides a unique opportunity to further validate these questionnaires in a broader, more real-life setting where the entire spectrum of patients with obstructive airway disease is represented. Moreover, since asthma and COPD represent a continuum of airway obstruction with heterogenous inflammatory mediators, deciding on an evaluation program based on a referral note may not be the optimal way to evaluate patients. Also, the traditional classification of these diseases based on clinical manifestations that does not distinguish between cellular and molecular mechanisms in the evaluation of obstructive airway disease may not be up to date.