INVITED REVIEW

You have free access to this content

Ambulatory models of care for obstructive sleep apnoea: Diagnosis and management

1. Ching Li Chai-Coetzer^1,2,*, 
2. Nick A. Antic^1,2, 
3. R. Doug McEvoy^1,2

Article first published online: 25 APR 2013

DOI: 10.1111/resp.12071

© 2013 Commonwealth of Australia. Respirology © 2013 Asian Pacific Society of Respirology

Issue

Respirology

Volume 18, Issue 4, pages 605–615, May 2013

View Full Article (HTML) Get PDF (185K)

Keywords:

• ambulatory care;
• continuous positive airway pressure;
• cost-effectiveness;
• obstructive sleep apnoea;
• polysomnography

Abstract

The high prevalence of obstructive sleep apnoea (OSA) and increasing awareness of its potential health consequences has placed significant pressure on laboratory-based sleep services leading to growing waiting lists and delays in diagnosis and treatment. Consequently, there has been increasing interest in the use of simplified, ambulatory models of care involving clinical prediction tools, portable sleep monitoring and home autotitrating continuous positive airway pressure. Researchers are also exploring the potential role for a wider range of health-care providers, including trained nurses and general practitioners, in the primary management of OSA. Recent randomized, controlled studies evaluating the clinical effectiveness of ambulatory management strategies versus traditional laboratory-based care for patients with OSA have consistently demonstrated that comparable patient outcomes can be achieved. The cost-effectiveness of these strategies is currently being debated, and further research examining the long-term economic implications of ambulatory models of care is needed.

View Full Article (HTML) Get PDF (185K)

Research

Increased number and altered phenotype of lymphatic vessels in peripheral lung compartments of patients with COPD

Michiko Mori, Cecilia K Andersson, Gerard J Graham, Claes-Göran Löfdahl and Jonas S Erjefält

For all author emails, please log on.

Respiratory Research 2013, 14:65 doi:10.1186/1465-9921-14-65

Published: 11 June 2013

Abstract (provisional)

Background

De novo lymphatic vessel formation has recently been observed in lungs of patients with moderate chronic obstructive pulmonary disease (COPD). However, the distribution of lymphatic vessel changes among the anatomical compartments of diseased lungs is unknown. Furthermore, information regarding the nature of lymphatic vessel alterations across different stages of COPD is missing. This study performs a detailed morphometric characterization of lymphatic vessels in major peripheral lung compartments of patients with different severities of COPD and investigates the lymphatic expression of molecules involved in immune cell trafficking.

Methods

Peripheral lung resection samples obtained from patients with mild (GOLD stage I), moderate-severe (GOLD stage II-III), and very severe (GOLD stage IV) COPD were investigated for podoplanin-immunopositive lymphatic vessels in distinct peripheral lung compartments: bronchioles, pulmonary blood vessels and alveolar walls. Control subjects with normal lung function were divided into never smokers and smokers. Lymphatics were analysed by multiple morphological parameters, as well as for their expression of CCL21 and the chemokine scavenger receptor D6.

Results

The number of lymphatics increased by 133% in the alveolar parenchyma in patients with advanced COPD compared with never-smoking controls (p - 0.05). In patchy fibrotic lesions the number of alveolar lymphatics increased 20-fold from non-fibrotic parenchyma in the same COPD patients. The absolute number of lymphatics per bronchiole and artery was increased in advanced COPD, but numbers were not different after normalization to tissue area. Increased numbers of CCL21- and D6-positive lymphatics were observed in the alveolar parenchyma in advanced COPD compared with controls (p - 0.01). Lymphatic vessels also displayed increased mean levels of immunoreactivity for CCL21 in the wall of bronchioles (p - 0.01) and bronchiole-associated arteries (p - 0.05), as well as the alveolar parenchyma (p < 0.001) in patients with advanced COPD compared with never-smoking controls. A similar increase in lymphatic D6 immunoreactivity was observed in bronchioles (p - 0.05) and alveolar parenchyma (p - 0.01).

Conclusions

This study shows that severe stages of COPD is associated with increased numbers of alveolar lymphatic vessels and a change in lymphatic vessel phenotype in major peripheral lung compartments. This novel histopathological feature is suggested to have important implications for distal lung immune cell traffic in advanced COPD.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

Research

Increase in sensitization to common airborne allergens among adults -- two population-based studies 15 years apart

Katja Warm, Anne Lindberg, Bo Lundbäck and Eva Rönmark

For all author emails, please log on.

Allergy, Asthma & Clinical Immunology 2013, 9:20 doi:10.1186/1710-1492-9-20

Published: 11 June 2013

Abstract (provisional)

Background

Studies on time trends of allergic sensitization among adults are rare. The aim of the study was to compare the prevalence of allergic sensitization to common airborne allergens among adults 15 years apart and to identify risk factors for allergic sensitization.

Methods

Clinical examinations including skin prick test (SPT) and structured interviews were performed in two random population samples in 1994 and 2009. Furthermore, specific IgE was analyzed in 2009. SPT data were available for 483 subjects in 1994 and for 463 subjects in 2009 in ages 20--60 years. Specific IgE was analyzed in 692 subjects in ages 20--79 years.

Results

Sensitization to cat (16% to 26%, p < 0.001), dog (13% to 25%, p - 0.001), birch (13% to 18%, p = 0.031) and timothy (12% to 21%, p - 0.001), based on SPT, increased significantly from 1994 to 2009. Sensitization to any positive SPT increased from 35% to 39%, p = 0.13.The proportion of having +=3 positive SPT reactions increased from 40% to 56%, p = 0.002. The sensitization pattern yielded similar results based on specific IgE. Risk factors for allergic sensitization were having a family history of allergy (OR 3.1, 95% CI 2.0-4.8 for any positive SPT; OR 2.7, 95% CI 1.8-4.0 for any elevated IgE) and urban living (OR 1.7, 95% CI 1.0-2.7; OR 1.5, 95% CI 1.0-2.4).

Conclusions

The prevalence of allergic sensitization to major airborne allergens as well as multi-sensitization increased significantly between the study years. Young age, a family history of allergy and urban living were significant risk factors for allergic sensitization.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

The Use of Humanized Monoclonal Antibodies for the Prevention of Respiratory Syncytial Virus Infection

Clinical and Developmental Immunology
Volume 2013 (2013), Article ID 359683, 9 pages
http://dx.doi.org/10.1155/2013/359683

Review Article

The Use of Humanized Monoclonal Antibodies for the Prevention of Respiratory Syncytial Virus Infection

Marcello Lanari,¹ Silvia Vandini,² Santo Arcuri,² Silvia Galletti,² and Giacomo Faldella²

¹Pediatrics and Neonatology Unit, Imola Hospital, Via Montericco 4, 40026 Imola, Italy
²Neonatology, S. Orsola-Malpighi Hospital, Via Massarenti 11, 40138 Bologna, Italy

Received 8 March 2013; Revised 13 May 2013; Accepted 20 May 2013

Academic Editor: Roberto Burioni

Copyright © 2013 Marcello Lanari et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Monoclonal antibodies are widely used both in infants and in adults for several indications. Humanized monoclonal antibodies (palivizumab) have been used for many years for the prevention of respiratory syncytial virus infection in pediatric populations (preterm infants, infants with chronic lung disease or congenital heart disease) at high risk of severe and potentially lethal course of the infection. This drug was reported to be safe, well tolerated and effective to decrease the hospitalization rate and mortality in these groups of infants by several clinical trials. In the present paper we report the development and the current use of monoclonal antibodies for prophylaxis against respiratory syncytial virus.

• Abstract
• Full-Text PDF
• Full-Text HTML
• Full-Text ePUB
• Linked References
• How to Cite this Article
• Complete Special Issue

Expert Review of Respiratory Medicine June 2013, Vol. 7, No. 3, Pages 197-199 , DOI 10.1586/ers.13.22 (doi:10.1586/ers.13.22) Editorial    Why are women more vulnerable to chronic obstructive pulmonary disease? Anthony Tam and Don D Sin* * Author for correspondence Full Text PDF (686 KB) PDF Plus (694 KB)

Summary

Expert Review of Respiratory Medicine

June 2013, Vol. 7, No. 3, Pages 213-230 , DOI 10.1586/ers.13.20

(doi:10.1586/ers.13.20)

Review

  

Recent advances in α-1-antitrypsin deficiency-related lung disease

Judith A Brebner^* and Robert A Stockley

* Author for correspondence

α-1-antitrypsin deficiency (A1ATD) is an under-recognized hereditary disorder associated with the premature onset of chronic obstructive pulmonary disease. There is considerable heterogeneity in the phenotypic expression of lung disease in A1ATD and the pathophysiology is complex, involving the interaction of multiple pathways. Other genetic factors that may contribute to emphysema risk in A1AT-deficient individuals are beginning to be identified. Methods of monitoring disease progression have evolved, including the use of computed tomography densitometry and biomarkers of disease activity. Progress in the development of novel treatment strategies continues, including the hope for a potential cure through the use of gene therapies. In this article, the authors review the recent advances in this field and outline potential future directions of research in A1ATD.

Full Text

PDF (2312 KB)

PDF Plus (2418 KB)

• Indian J Dermatol
• v.58(3); May-Jun 2013
• PMC3667293

Indian J Dermatol. 2013 May-Jun; 58(3): 239.

doi:  10.4103/0019-5154.110839

PMCID: PMC3667293

Hypoallergenic Diet Can Influence the Severity of Atopic Dermatitis

Jarmila Čelakovská and Josef Bukač1

Author information ► Article notes ► Copyright and License information ►

Go to:

Abstract

Aim:

To evaluate with SCORAD system the contribution of the diagnostic hypoallergenic diet on the severity of atopic dermatitis and especially on the the intensity criteria and subjective parametersin patients over 14 years of age.

Materials and Methods:

The diagnostichypoallergenic diet was recommended for the period of 3 weeks. Severity of eczema was scored in agreement with SCORAD score, and especially the intensity criteria (erythema, edema, crusting, excoriations, lichenifications, dryness) and subjective parameters (pruritus, sleeplessness) were evaluated at the beginning and at the end of this diet.

Results:

One hundred and forty-eight patients suffering from atopic dermatitis were included in the study: 107 women and 41 men with the average age of 26.03 (s.d. 9.6 years), min. 14 max. 63 years. In the end of 3 weeks diagnostic hypoallergenic diet there was a statistically significant reduction in severity of sleepless and pruritus and in all of the intensity criteria except of lichenification.

Conclusion:

The diagnostic hypoallergenic diet can improve the intensity criteria and subjective parameters of atopic dermatitis evaluated in SCORAD, but not the lichenification. We recommend to introduce this diet before a challenge tests and as a temporary medical arrangement in patients suffering from moderate or severe form of atopic dermatitis.

Keywords: Atopic dermatitis, crusting, diagnostic hypoallergenic diet, dryness, erythema,excoriations, lichenifications, edema, SCORAD, sleeplessness, pruritus

Formats:

• Article
 | 
• PubReader
 | 
• ePub (beta)
 | 
• Printer Friendly

OPEN ACCESS PEER-REVIEWED

RESEARCH ARTICLE

A Mechanical Design Principle for Tissue Structure and Function in the Airway Tree

• Adam S. LaPrad,
 
• Kenneth R. Lutchen,
 
• Béla Suki mail

Abstract

With every breath, the dynamically changing mechanical pressures must work in unison with the cells and soft tissue structures of the lung to permit air to efficiently traverse the airway tree and undergo gas exchange in the alveoli. The influence of mechanics on cell and tissue function is becoming apparent, raising the question: how does the airway tree co-exist within its mechanical environment to maintain normal cell function throughout its branching structure of diminishing dimensions? We introduce a new mechanical design principle for the conducting airway tree in which mechanotransduction at the level of cells is driven to orchestrate airway wall structural changes that can best maintain a preferred mechanical microenvironment. To support this principle, we report in vitro radius-transmural pressure relations for a range of airway radii obtained from healthy bovine lungs and model the data using a strain energy function together with a thick-walled cylinder description. From this framework, we estimate circumferential stresses and incremental Young's moduli throughout the airway tree. Our results indicate that the conducting airways consistently operate within a preferred mechanical homeostatic state, termed mechanical homeostasis, that is characterized by a narrow range of circumferential stresses and Young's moduli. This mechanical homeostatic state is maintained for all airways throughout the tree via airway wall dimensional and mechanical relationships. As a consequence, cells within the airway walls throughout the airway tree experience similar oscillatory strains during breathing that are much smaller than previously thought. Finally, we discuss the potential implications of how the maintenance of mechanical homeostasis, while facilitating healthy tissue-level alterations necessary for maturation, may lead to airway wall structural changes capable of chronic asthma.

Formats:

• Article
 | 
• PubReader
 | 
• ePub (beta)
 | 
• PDF (415K)

Download

Print

Share