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Egenod T, Deslee G, Degano B. [Bronchoscopic COPD treatments]. Rev Mal Respir 2023; 40:820-833. [PMID: 37684196 DOI: 10.1016/j.rmr.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/18/2023] [Indexed: 09/10/2023]
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is associated with disabling respiratory symptoms including dyspnea, frequent exacerbations and chronic bronchitis. The currently available pharmacological and non-pharmacological therapies have limited efficacy, necessitating the development of interventional strategies, many of them endoscopic. STATE OF THE ART Endoscopic lung volume reduction has markedly increased over recent years, principally as regards the endobronchial valves currently used in routine care. Indeed, multiple randomized trials have demonstrated a significant clinical benefit in a selected population identifiable due to the absence of interlobar collateral ventilation. Other endoscopic volume reduction techniques (polymers, thermal vapor, spirals) shall require additional studies before being considered as options in routine care. Targeted lung denervation (TLD) has aroused interest as a means of reducing exacerbations in the early phases of relevant studies. Endobronchial techniques (bronchoscopic cryospray, bronchial rheoplasty) are still at a very early stage of development, which is aimed at reducing the symptoms of chronic bronchitis. OUTLOOK Aside from endobronchial valves, which are currently employed in routine care, all the above-mentioned endoscopic techniques require additional studies in order to determine their benefit/risk balance and to identify the population that would benefit the most. CONCLUSIONS Endoscopic treatments constitute a major avenue of research and innovation in the therapeutic management of COPD. Inclusion of patients in disease registries and clinical trials remains essential, the objective being to gauge the interest of these treatments and their future role in everyday COPD management.
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Affiliation(s)
- T Egenod
- Alpes, Inserm 1300, Grenoble, France.
| | - G Deslee
- Service de pneumologie, hôpital universitaire Dupuytren, Limoges, France
| | - B Degano
- Service de pneumologie, hôpital Maison Blanche, Inserm UMRS-1250, université Reims Champagne Ardenne, Reims, France
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2
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Mifflin KA, Brennan FH, Guan Z, Kigerl KA, Filous AR, Mo X, Schwab JM, Popovich PG. Spinal Cord Injury Impairs Lung Immunity in Mice. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2022; 209:157-170. [PMID: 35697382 PMCID: PMC9246940 DOI: 10.4049/jimmunol.2200192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/22/2022] [Indexed: 06/15/2023]
Abstract
Pulmonary infection is a leading cause of morbidity and mortality after spinal cord injury (SCI). Although SCI causes atrophy and dysfunction in primary and secondary lymphoid tissues with a corresponding decrease in the number and function of circulating leukocytes, it is unknown whether this SCI-dependent systemic immune suppression also affects the unique tissue-specific antimicrobial defense mechanisms that protect the lung. In this study, we tested the hypothesis that SCI directly impairs pulmonary immunity and subsequently increases the risk for developing pneumonia. Using mouse models of severe high-level SCI, we find that recruitment of circulating leukocytes and transcriptional control of immune signaling in the lung is impaired after SCI, creating an environment that is permissive for infection. Specifically, we saw a sustained loss of pulmonary leukocytes, a loss of alveolar macrophages at chronic time points postinjury, and a decrease in immune modulatory genes, especially cytokines, needed to eliminate pulmonary infections. Importantly, this injury-dependent impairment of pulmonary antimicrobial defense is only partially overcome by boosting the recruitment of immune cells to the lung with the drug AMD3100, a Food and Drug Administration-approved drug that mobilizes leukocytes and hematopoietic stem cells from bone marrow. Collectively, these data indicate that the immune-suppressive effects of SCI extend to the lung, a unique site of mucosal immunity. Furthermore, preventing lung infection after SCI will likely require novel strategies, beyond the use of orthodox antibiotics, to reverse or block tissue-specific cellular and molecular determinants of pulmonary immune surveillance.
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Affiliation(s)
- Katherine A Mifflin
- Department of Neuroscience, The Ohio State University, Columbus, OH
- Belford Center for Spinal Cord Injury, The Ohio State University, Columbus, OH
- Center for Brain and Spinal Cord Repair, The Ohio State University, Columbus, OH
| | - Faith H Brennan
- Department of Neuroscience, The Ohio State University, Columbus, OH
- Belford Center for Spinal Cord Injury, The Ohio State University, Columbus, OH
- Center for Brain and Spinal Cord Repair, The Ohio State University, Columbus, OH
| | - Zhen Guan
- Department of Neuroscience, The Ohio State University, Columbus, OH
- Belford Center for Spinal Cord Injury, The Ohio State University, Columbus, OH
- Center for Brain and Spinal Cord Repair, The Ohio State University, Columbus, OH
| | - Kristina A Kigerl
- Department of Neuroscience, The Ohio State University, Columbus, OH
- Belford Center for Spinal Cord Injury, The Ohio State University, Columbus, OH
- Center for Brain and Spinal Cord Repair, The Ohio State University, Columbus, OH
| | - Angela R Filous
- Belford Center for Spinal Cord Injury, The Ohio State University, Columbus, OH
- Center for Brain and Spinal Cord Repair, The Ohio State University, Columbus, OH
- Department of Neurology, The Ohio State University, Wexner Medical Center, Columbus, OH; and
| | - Xiaokui Mo
- Department of Biomedical Informatics, The Ohio State University, Center for Biostatistics, Columbus, OH
| | - Jan M Schwab
- Department of Neuroscience, The Ohio State University, Columbus, OH
- Belford Center for Spinal Cord Injury, The Ohio State University, Columbus, OH
- Center for Brain and Spinal Cord Repair, The Ohio State University, Columbus, OH
- Department of Neurology, The Ohio State University, Wexner Medical Center, Columbus, OH; and
| | - Phillip G Popovich
- Department of Neuroscience, The Ohio State University, Columbus, OH;
- Belford Center for Spinal Cord Injury, The Ohio State University, Columbus, OH
- Center for Brain and Spinal Cord Repair, The Ohio State University, Columbus, OH
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Mehra R, Tjurmina OA, Ajijola OA, Arora R, Bolser DC, Chapleau MW, Chen PS, Clancy CE, Delisle BP, Gold MR, Goldberger JJ, Goldstein DS, Habecker BA, Handoko ML, Harvey R, Hummel JP, Hund T, Meyer C, Redline S, Ripplinger CM, Simon MA, Somers VK, Stavrakis S, Taylor-Clark T, Undem BJ, Verrier RL, Zucker IH, Sopko G, Shivkumar K. Research Opportunities in Autonomic Neural Mechanisms of Cardiopulmonary Regulation: A Report From the National Heart, Lung, and Blood Institute and the National Institutes of Health Office of the Director Workshop. JACC Basic Transl Sci 2022; 7:265-293. [PMID: 35411324 PMCID: PMC8993767 DOI: 10.1016/j.jacbts.2021.11.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 12/22/2022]
Abstract
This virtual workshop was convened by the National Heart, Lung, and Blood Institute, in partnership with the Office of Strategic Coordination of the Office of the National Institutes of Health Director, and held September 2 to 3, 2020. The intent was to assemble a multidisciplinary group of experts in basic, translational, and clinical research in neuroscience and cardiopulmonary disorders to identify knowledge gaps, guide future research efforts, and foster multidisciplinary collaborations pertaining to autonomic neural mechanisms of cardiopulmonary regulation. The group critically evaluated the current state of knowledge of the roles that the autonomic nervous system plays in regulation of cardiopulmonary function in health and in pathophysiology of arrhythmias, heart failure, sleep and circadian dysfunction, and breathing disorders. Opportunities to leverage the Common Fund's SPARC (Stimulating Peripheral Activity to Relieve Conditions) program were characterized as related to nonpharmacologic neuromodulation and device-based therapies. Common themes discussed include knowledge gaps, research priorities, and approaches to develop novel predictive markers of autonomic dysfunction. Approaches to precisely target neural pathophysiological mechanisms to herald new therapies for arrhythmias, heart failure, sleep and circadian rhythm physiology, and breathing disorders were also detailed.
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Key Words
- ACE, angiotensin-converting enzyme
- AD, autonomic dysregulation
- AF, atrial fibrillation
- ANS, autonomic nervous system
- Ach, acetylcholine
- CNS, central nervous system
- COPD, chronic obstructive pulmonary disease
- CSA, central sleep apnea
- CVD, cardiovascular disease
- ECG, electrocardiogram
- EV, extracellular vesicle
- GP, ganglionated plexi
- HF, heart failure
- HFpEF, heart failure with preserved ejection fraction
- HFrEF, heart failure with reduced ejection fraction
- HRV, heart rate variability
- LQT, long QT
- MI, myocardial infarction
- NE, norepinephrine
- NHLBI, National Heart, Lung, and Blood Institute
- NPY, neuropeptide Y
- NREM, non-rapid eye movement
- OSA, obstructive sleep apnea
- PAH, pulmonary arterial hypertension
- PV, pulmonary vein
- REM, rapid eye movement
- RV, right ventricular
- SCD, sudden cardiac death
- SDB, sleep disordered breathing
- SNA, sympathetic nerve activity
- SNSA, sympathetic nervous system activity
- TLD, targeted lung denervation
- asthma
- atrial fibrillation
- autonomic nervous system
- cardiopulmonary
- chronic obstructive pulmonary disease
- circadian
- heart failure
- pulmonary arterial hypertension
- sleep apnea
- ventricular arrhythmia
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Affiliation(s)
- Reena Mehra
- Cleveland Clinic, Cleveland, Ohio, USA
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Olga A. Tjurmina
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | | | - Rishi Arora
- Feinberg School of Medicine at Northwestern University, Chicago, Illinois, USA
| | | | - Mark W. Chapleau
- University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | | | | | | | - Michael R. Gold
- Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - David S. Goldstein
- National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA
| | - Beth A. Habecker
- Oregon Health and Science University School of Medicine, Portland, Oregon, USA
| | - M. Louis Handoko
- Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | | | - James P. Hummel
- Yale University School of Medicine, New Haven, Connecticut, USA
| | | | | | | | | | - Marc A. Simon
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- University of California-San Francisco, San Francisco, California, USA
| | | | - Stavros Stavrakis
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | | | | | - Richard L. Verrier
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - George Sopko
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
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4
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Slebos DJ, Shah PL, Herth FJF, Pison C, Schumann C, Hübner RH, Bonta PI, Kessler R, Gesierich W, Darwiche K, Lamprecht B, Perez T, Skowasch D, Deslee G, Marceau A, Sciurba FC, Gosens R, Hartman JE, Srikanthan K, Duller M, Valipour A. Safety and Adverse Events after Targeted Lung Denervation for Symptomatic Moderate to Severe Chronic Obstructive Pulmonary Disease (AIRFLOW). A Multicenter Randomized Controlled Clinical Trial. Am J Respir Crit Care Med 2020; 200:1477-1486. [PMID: 31404499 PMCID: PMC6909835 DOI: 10.1164/rccm.201903-0624oc] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Rationale: Targeted lung denervation (TLD) is a bronchoscopic radiofrequency ablation therapy for chronic obstructive pulmonary disease (COPD), which durably disrupts parasympathetic pulmonary nerves to decrease airway resistance and mucus hypersecretion. Objectives: To determine the safety and impact of TLD on respiratory adverse events. Methods: We conducted a multicenter, randomized, sham bronchoscopy–controlled, double-blind trial in patients with symptomatic (modified Medical Research Council dyspnea scale score, ≥2; or COPD Assessment Test score, ≥10) COPD (FEV1, 30–60% predicted). The primary endpoint was the rate of respiratory adverse events between 3 and 6.5 months after randomization (defined as COPD exacerbation, tachypnea, wheezing, worsening bronchitis, worsening dyspnea, influenza, pneumonia, other respiratory infections, respiratory failure, or airway effects requiring therapeutic intervention). Blinding was maintained through 12.5 months. Measurements and Main Results: Eighty-two patients (50% female; mean ± SD: age, 63.7 ± 6.8 yr; FEV1, 41.6 ± 7.3% predicted; modified Medical Research Council dyspnea scale score, 2.2 ± 0.7; COPD Assessment Test score, 18.4 ± 6.1) were randomized 1:1. During the predefined 3- to 6.5-month window, patients in the TLD group experienced significantly fewer respiratory adverse events than those in the sham group (32% vs. 71%, P = 0.008; odds ratio, 0.19; 95% confidence interval, 0.0750–0.4923, P = 0.0006). Between 0 and 12.5 months, these findings were not different (83% vs. 90%; P = 0.52). The risk of COPD exacerbation requiring hospitalization in the 0- to 12.5-month window was significantly lower in the TLD group than in the sham group (hazard ratio, 0.35; 95% confidence interval, 0.13–0.99; P = 0.039). There was no statistical difference in the time to first moderate or severe COPD exacerbation, patient-reported symptoms, or other physiologic measures over the 12.5 months of follow-up. Conclusions: Patients with symptomatic COPD treated with TLD combined with optimal pharmacotherapy had fewer study-defined respiratory adverse events, including hospitalizations for COPD exacerbation. Clinical trial registered with www.clinicaltrials.gov (NCT02058459).
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Affiliation(s)
| | - Pallav L Shah
- Royal Brompton & Harefield NHS Trust, Chelsea & Westminster Hospital and Imperial College London, London, United Kingdom
| | - Felix J F Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, and.,Translational Lung Research Center Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Christophe Pison
- CHU Grenoble Alpes, Service Universitaire Pneumologie Physiologie, Université Grenoble Alpes, Grenoble, France
| | - Christian Schumann
- Clinic of Pneumology, Thoracic Oncology, Sleep and Respiratory Critical Care, Klinikverbund Kempten-Oberallgäu, Kempten and Immenstadt, Germany
| | - Ralf-Harto Hübner
- Charité Universitätsmedizin Berlin, Medizinische Klinik m. Schw. Infektiologie und Pneumologie, Campus Virchow, Berlin, Germany
| | - Peter I Bonta
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Romain Kessler
- Service de Pneumologie, Nouvel Hôpital Civil, Université de Strasbourg, Strasbourg, France
| | - Wolfgang Gesierich
- Asklepios-Fachkliniken Munich-Gauting, Comprehensive Pneumology Center Munich, Gauting, Germany
| | - Kaid Darwiche
- Department of Pulmonary Medicine, Section of Interventional Pneumology, Ruhrlandklinik-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Bernd Lamprecht
- Department of Pulmonary Medicine, Kepler Universitatsklinikum GmbH, Linz, Austria
| | | | - Dirk Skowasch
- Department of Internal Medicine II-Cardiology/Pneumology, University of Bonn, Bonn, Germany
| | - Gaetan Deslee
- CHU de Reims, Hôpital Maison Blanche, Service de Pneumologie, Reims, France
| | - Armelle Marceau
- Service de Pneumologie, Hôpital Universitaire Bichat, Paris, France
| | - Frank C Sciurba
- Department of Molecular Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Reinoud Gosens
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and
| | | | - Karthi Srikanthan
- Royal Brompton & Harefield NHS Trust, Chelsea & Westminster Hospital and Imperial College London, London, United Kingdom
| | - Marina Duller
- Department of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Krankenhaus Nord-Klinik Floridsdorf, Vienna, Austria
| | - Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Krankenhaus Nord-Klinik Floridsdorf, Vienna, Austria
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5
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Wang K, Sun J, Gao W, Chen R, Wu X, He Y, Guo Q, Zhang X, Li Q. Feasibility, effectiveness, and safety of a novel cryo-balloon targeted lung denervation technique in an animal model. Cryobiology 2020; 93:27-32. [PMID: 32165141 DOI: 10.1016/j.cryobiol.2020.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/03/2020] [Accepted: 03/03/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Targeted lung denervation (TLD) is a pulmonary interventional procedure for COPD that aims to disrupt parasympathetic nerve input to the lung to reduce the clinical consequences of cholinergic hyperactivity. TLD has been proven to be a safe procedure and effectively alleviate symptoms and reduce the onset of exacerbation. In the present study, we developed a novel cryo-balloon TLD system and evaluated its feasibility, safety, and effectiveness. METHODS A preclinical study was performed on twelve sheep, four were tested for airway resistance alterations before and after TLD, two were tested for the Hering-Breuer reflex (HBR) and the remaining six sheep were evaluated for 28 days to assess the safety and effectiveness of the procedure. RESULTS After an observation period of 28 days, significant disruption of vagal innervation to the lung could be validated by both histological and physiological assessments. The operation time was shorter than traditional procedure, with minimal adjacent tissue injury and no device-related adverse events. CONCLUSIONS The novel cryo-balloon TLD procedure was feasible, safe, and effective. In comparison with the traditional procedure, this treatment system required shorter operation time and caused less denervation-induced damage to adjacent tissues.
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Affiliation(s)
- Kun Wang
- Department of Pulmonary and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201620, China; Department of Pulmonary and Critical Care Medicine, Shanghai East Hospital, Tongji University, Shanghai, 200120, China
| | - Jiaxing Sun
- Department of Pulmonary and Critical Care Medicine, Shanghai East Hospital, Tongji University, Shanghai, 200120, China
| | - Wei Gao
- Department of Pulmonary and Critical Care Medicine, Shanghai East Hospital, Tongji University, Shanghai, 200120, China
| | - Rongzhang Chen
- Department of Pulmonary and Critical Care Medicine, Shanghai East Hospital, Tongji University, Shanghai, 200120, China
| | - Xiaodong Wu
- Department of Pulmonary and Critical Care Medicine, Shanghai East Hospital, Tongji University, Shanghai, 200120, China
| | - Yanan He
- Department of Pulmonary and Critical Care Medicine, Shanghai East Hospital, Tongji University, Shanghai, 200120, China
| | - Qian Guo
- Department of Pulmonary and Critical Care Medicine, Shanghai East Hospital, Tongji University, Shanghai, 200120, China
| | - Xin Zhang
- Department of Pulmonary and Critical Care Medicine, People's Liberation Army Joint Logistic Support Force 920th Hospital, 650032, China.
| | - Qiang Li
- Department of Pulmonary and Critical Care Medicine, Shanghai East Hospital, Tongji University, Shanghai, 200120, China.
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6
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Valipour A, Shah PL, Pison C, Ninane V, Janssens W, Perez T, Kessler R, Deslee G, Garner J, Abele C, Hartman JE, Slebos DJ. Safety and Dose Study of Targeted Lung Denervation in Moderate/Severe COPD Patients. Respiration 2019; 98:329-339. [PMID: 31220851 DOI: 10.1159/000500463] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 04/16/2019] [Indexed: 12/14/2022] Open
Abstract
RATIONALE Targeted lung denervation (TLD) is a novel bronchoscopic treatment for the disruption of parasympathetic innervation of the lungs. OBJECTIVES To assess safety, feasibility, and dosing of TLD in patients with moderate to severe COPD using a novel device design. METHODS Thirty patients with COPD (forced expiratory volume in 1 s 30-60%) were 1:1 randomized in a double-blinded fashion to receive TLD with either 29 or 32 W. Primary endpoint was the rate of TLD-associated adverse airway effects that required treatment through 3 months. Assessments of lung function, quality of life, dyspnea, and exercise capacity were performed at baseline and 1-year follow-up. An additional 16 patients were enrolled in an open-label confirmation phase study to confirm safety improvements after procedural enhancements following gastrointestinal adverse events during the randomized part of the trial. RESULTS Procedural success, defined as device success without an in-hospital serious adverse event, was 96.7% (29/30). The rate of TLD-associated adverse airway effects requiring intervention was 3/15 in the 32 W versus 1/15 in the 29 W group, p = 0.6. Five patients early in the randomized phase experienced serious gastric events. The study was stopped and procedural changes made that reduced both gastrointestinal and airway events in the subsequent phase of the randomized trial and follow-up confirmation study. Improvements in lung function and quality of life were observed compared to baseline values for both doses but were not statistically different. CONCLUSIONS The results demonstrate acceptable safety and feasibility of TLD in patients with COPD, with improvements in adverse event rates after procedural enhancements.
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Affiliation(s)
- Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Ludwig-Boltzmann-Institute for COPD and Respiratory Epidemiology, Otto-Wagner-Spital, Vienna, Austria
| | - Pallav L Shah
- Royal Brompton and Harefield NHS Trust, Chelsea and Westminster Hospital, and Imperial College, London, United Kingdom
| | - Christophe Pison
- Service Hospitalier Universitaire Pneumologie Physiologie, Centre Hospitalier Universitaire Grenoble Alpes, InsermU1055, Université Grenoble Alpes, Grenoble, France
| | - Vincent Ninane
- CHU Saint-Pierre, Université libre de Bruxelles, Bruxelles, Belgium
| | - Wim Janssens
- Department of Respiratory Diseases, KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Thierry Perez
- CHU Lille, Center for Infection and Immunity of Lille, INSERM U1019, CNRS UMR 8204 Univ Lille Nord de France, Lille, France
| | - Romain Kessler
- Service de Pneumologie, Nouvel Hôpital Civil, Université de Strasbourg, Strasbourg, France
| | - Gaetan Deslee
- CHU de Reims, Hôpital Maison Blanche, INSERM UMRS 1250, Service de Pneumologie, Reims, France
| | - Justin Garner
- Royal Brompton and Harefield NHS Trust, Chelsea and Westminster Hospital, and Imperial College, London, United Kingdom
| | - Christine Abele
- Department of Respiratory and Critical Care Medicine, Ludwig-Boltzmann-Institute for COPD and Respiratory Epidemiology, Otto-Wagner-Spital, Vienna, Austria
| | - Jorine E Hartman
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands,
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Cazzola M, Calzetta L, Ora J, Puxeddu E, Rogliani P, Matera MG. Searching for the synergistic effect between aclidinium and formoterol: From bench to bedside. Respir Med 2015; 109:1305-11. [DOI: 10.1016/j.rmed.2015.08.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 07/20/2015] [Accepted: 08/10/2015] [Indexed: 11/24/2022]
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8
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Cazzola M, Calzetta L, Segreti A, Facciolo F, Rogliani P, Matera MG. Translational Study Searching for Synergy between Glycopyrronium and Indacaterol. COPD 2014; 12:175-81. [PMID: 25222881 DOI: 10.3109/15412555.2014.922172] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We aimed to explore whether the acute bronchodilation induced by indacaterol 150 μg and glycopyrronium bromide 50 μg is additive or synergistic with respect to monocomponents by testing the type of effect ex vivo on isolated human bronchi and then in vivo in COPD patients. Both indacaterol and glycopyrronium caused a concentration-dependent relaxation of human isolated bronchial tissues sub-maximally pre-contracted with acetylcholine; glycopyrronium was significantly more potent than indacaterol. The analysis of data using the Bliss Independence (BI) criterion indicated that glycopyrronium plus indacaterol produced an additive interaction at the isoeffective concentrations inducing EC20 and a significant synergistic relaxant effect at isoeffective concentrations inducing EC30. In COPD patients, the inhalation of indacaterol and glycopyrronium in combination significantly anticipated at 15 min post-administration the mean peak of bronchodilatory effect compared to the two drugs administered alone. The study of interaction between indacaterol and glycopyrronium by BI analysis evidenced an additive effect for FEV1 between 5 min and 180 min post-inhalation, with synergistic interaction at 15 min post-administration, compared to the bronchodilation induced by these drugs administered alone. This study suggests that the combination ensures a broncholytic effect that is greater than that induced by the single monocomponents.
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Affiliation(s)
- Mario Cazzola
- 1Department of Systems Medicine, University of Rome Tor Vergata , Rome , Italy
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9
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Murphy SR, Oslund KL, Hyde DM, Miller LA, Van Winkle LS, Schelegle ES. Ozone-induced airway epithelial cell death, the neurokinin-1 receptor pathway, and the postnatal developing lung. Am J Physiol Lung Cell Mol Physiol 2014; 307:L471-81. [PMID: 25063800 DOI: 10.1152/ajplung.00324.2013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Children are uniquely susceptible to ozone because airway and lung growth continue for an extensive period after birth. Early-life exposure of the rhesus monkey to repeated ozone cycles results in region-specific disrupted airway/lung growth, but the mediators and mechanisms are poorly understood. Substance P (SP), neurokinin-1 receptor (NK-1R); and nuclear receptor Nur77 (NR4A1) are signaling pathway components involved in ozone-induced cell death. We hypothesize that acute ozone (AO) exposure during postnatal airway development disrupts SP/NK-1R/Nur77 pathway expression and that these changes correlate with increased ozone-induced cell death. Our objectives were to 1) spatially define the normal development of the SP/NK-1R/Nur77 pathway in conducting airways; 2) compare how postnatal age modulates responses to AO exposure; and 3) determine how concomitant, episodic ozone exposure modifies age-specific acute responses. Male infant rhesus monkeys were assigned at age 1 mo to two age groups, 2 or 6 mo, and then to one of three exposure subgroups: filtered air (FA), FA+AO (AO: 8 h/day × 2 days), or episodic biweekly ozone exposure cycles (EAO: 8 h/day × 5 days/14-day cycle+AO). O3 = 0.5 ppm. We found that 1) ozone increases SP/NK-1R/Nur77 pathway expression in conducting airways, 2) an ozone exposure cycle (5 days/cycle) delivered early at age 2 mo resulted in an airway that was hypersensitive to AO exposure at the end of 2 mo, and 3) continued episodic exposure (11 cycles) resulted in an airway that was hyposensitive to AO exposure at 6 mo. These observations collectively associate with greater overall inflammation and epithelial cell death, particularly in early postnatal (2 mo), distal airways.
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Affiliation(s)
- Shannon R Murphy
- Center for Health and the Environment, University of California-Davis, Davis, California
| | - Karen L Oslund
- California National Primate Research Center, University of California-Davis, Davis, California; and
| | - Dallas M Hyde
- California National Primate Research Center, University of California-Davis, Davis, California; and School of Veterinary Medicine, Department of Anatomy, Physiology and Cell Biology, University of California-Davis, Davis, California
| | - Lisa A Miller
- California National Primate Research Center, University of California-Davis, Davis, California; and School of Veterinary Medicine, Department of Anatomy, Physiology and Cell Biology, University of California-Davis, Davis, California
| | - Laura S Van Winkle
- Center for Health and the Environment, University of California-Davis, Davis, California; School of Veterinary Medicine, Department of Anatomy, Physiology and Cell Biology, University of California-Davis, Davis, California
| | - Edward S Schelegle
- California National Primate Research Center, University of California-Davis, Davis, California; and School of Veterinary Medicine, Department of Anatomy, Physiology and Cell Biology, University of California-Davis, Davis, California
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Reinero CR, DeClue AE, Rabinowitz P. Asthma in humans and cats: is there a common sensitivity to aeroallegens in shared environments? ENVIRONMENTAL RESEARCH 2009; 109:634-640. [PMID: 19281975 DOI: 10.1016/j.envres.2009.02.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Revised: 01/23/2009] [Accepted: 02/02/2009] [Indexed: 05/27/2023]
Abstract
Cats spontaneously develop eosinophilic airway inflammation and airway hyperreactivity that is very similar to human allergic asthma. In addition, household cats share environmental exposures to aeroallergens with humans. We review the scientific literature concerning the pathophysiology of feline asthma, including similarities to human asthma and evidence regarding environmental aeroallergen triggers. Results of pathophysiological studies suggest important similarities between human and feline responses to inhaled allergens. Only a few studies were found that examined the development of disease in cats to environmental aeroallergens. Limited evidence suggests that some environmental allergens can cause disease in both cats and humans. It appears that there is a need for greater communication between human and animal health professionals regarding environmental causes of asthma. Specifically, additional research into linkages between human and feline asthma using both molecular techniques and clinical epidemiological approaches could lead to improved understanding of the environmental risks. Finally, there should be consideration of use of naturally affected and/or experimentally induced (using clinically relevant allergens) asthmatic cats in preclinical trials for novel therapeutic interventions.
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Affiliation(s)
- Carol R Reinero
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri-Columbia, 900 East Campus Drive, Columbia, MO 65211, USA.
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Bir LS, Ozkurt S, Daloğlu G, Kurt T. Impaired sympathetic skin response in chronic obstructive pulmonary disease. TOHOKU J EXP MED 2005; 207:243-8. [PMID: 16272793 DOI: 10.1620/tjem.207.243] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The sympathetic skin response (SSR) is considered as one of the indexes of autonomic nervous system functions, especially related with the sudomotor function of unmyelinated sympathetic fibers. SSRs are recorded as the potentials with biphasic or multiphasic waveforms by conventional electromyography. SSRs are evaluated by measuring latency (time from the stimulus to the onset), amplitude, and area (the space under the curve of the waveform). Although dysautonomia is a feature of chronic obstructive pulmonary disease (COPD), as demonstrated by acetylcholine sweat-spot test, there are no data concerning SSR in COPD patients. In this study, we electrophysiologically investigated the sudomotor function of the sympathetic nervous system in patients with COPD. SSRs were recorded in 30 patients with COPD and 21 healthy volunteers. Normal responses were obtained from all subjects in the control group. No response was observed in three patients with COPD. The mean latency, amplitude and area values of the potentials recorded of the remaining 27 patients were compared to the control. The mean latency was longer (p<0.01) and the mean amplitude and area values were lower (p=0.012, p=0.021, respectively) in the patients compared to the control. We also demonstrated significant correlations between the latency, amplitude, or area values of the SSR and two parameters of pulmonary function tests forced expiratory volume one second/forced vital capacity (FEV1/FVC) and FEV1/FVC %. In conclusion, SSR is impaired in patients with COPD, which indicates the dysfunction of the sympathetic nervous system. Furthermore, the degree of impairment in SSR may reflect the severity of airway obstruction in patients with COPD.
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Affiliation(s)
- Levent Sinan Bir
- Department of Neurology, Pamukkale University Faculty of Medicine, Denzli, and Department of Neurology, Atatürk Education and Research Hospital Izmir, Turkey.
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Rivero DH, Lorenzi-Filho G, Pazetti R, Jatene FB, Saldiva PH. Effects of Bronchial Transection and Reanastomosis on Mucociliary System. Chest 2001; 119:1510-5. [PMID: 11348961 DOI: 10.1378/chest.119.5.1510] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES The mechanisms involved in the impairment of mucociliary function after lung transplantation are not completely understood. The purpose of the present study was to isolate the effects of unilateral bronchial transection and reanastomosis in a rat model. DESIGN In situ bronchial mucociliary transport (MCT) was determined proximal and distal to the bronchial anastomosis, as well as in the right bronchus, in 48 rats classified into six groups: intact rats, and rats at 1 day, 2 days, 7 days, 15 days, and 30 days after bronchial transection and reanastomosis of the left main stem bronchus. In vitro mucus transportability and mucus contact angle were studied in another group of eight rats after 1 week of surgery. RESULTS Distal to the anastomosis site, left bronchus in situ MCT (mean +/- SD) was 0.26 +/- 0.19 mm/min for the intact group, and 0.11 +/- 0.13 mm/min, 0.07 +/- 0.04 mm/min, 0.03 +/- 0.04 mm/min, 0.07 +/- 0.12 mm/min, and 0.05 +/- 0.06 mm/min for 1 day, 2 days, 7 days, 15 days, and 30 days after surgery, respectively (all significantly reduced, p < 0.05). No intergroup differences were found proximal to the anastomosis (p = 0.30). When comparing the left and right bronchi, differences were detected in both distal (p < 0.0001) and proximal sides (p = 0.0001). No significant differences in mucus transportability in vitro were found (p = 0.15). Mucus contact angle of the left bronchus (52.8 +/- 20.5 degrees ) was significantly greater than that of the mucus from the right bronchus (34.4 +/- 12.9 degrees; p < 0.05). CONCLUSIONS We conclude that bronchial transection and reanastomosis lead to a marked impairment of MCT in distal airways, which can in part be explained by alterations in the surface properties of mucus.
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Affiliation(s)
- D H Rivero
- Department of Cardio-Pneumology, School of Medicine, São Paulo University, Brazil.
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Schelegle ES, Gershwin LJ, Miller LA, Fanucchi MV, Van Winkle LS, Gerriets JP, Walby WF, Omlor AM, Buckpitt AR, Tarkington BK, Wong VJ, Joad JP, Pinkerton KB, Wu R, Evans MJ, Hyde DM, Plopper CG. Allergic asthma induced in rhesus monkeys by house dust mite (Dermatophagoides farinae). THE AMERICAN JOURNAL OF PATHOLOGY 2001; 158:333-41. [PMID: 11141508 PMCID: PMC1850255 DOI: 10.1016/s0002-9440(10)63973-9] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
To establish whether allergic asthma could be induced experimentally in a nonhuman primate using a common human allergen, three female rhesus monkeys (Macaca mulatta) were sensitized with house dust mite (Dermatophagoides farinae) allergen (HDMA) by subcutaneous injection, followed by four intranasal sensitizations, and exposure to allergen aerosol 3 hours per day, 3 days per week for up to 13 weeks. Before aerosol challenge, all three monkeys skin-tested positive for HDMA. During aerosol challenge with HDMA, sensitized monkeys exhibited cough and rapid shallow breathing and increased airway resistance, which was reversed by albuterol aerosol treatment. Compared to nonsensitized monkeys, there was a fourfold reduction in the dose of histamine aerosol necessary to produce a 150% increase in airway resistance in sensitized monkeys. After aerosol challenge, serum levels of histamine were elevated in sensitized monkeys. Sensitized monkeys exhibited increased levels of HDMA-specific IgE in serum, numbers of eosinophils and exfoliated cells within lavage, and elevated CD25 expression on circulating CD4(+) lymphocytes. Intrapulmonary bronchi of sensitized monkeys had focal mucus cell hyperplasia, interstitial infiltrates of eosinophils, and thickening of the basement membrane zone. We conclude that a model of allergic asthma can be induced in rhesus monkeys using a protocol consisting of subcutaneous injection, intranasal instillation, and aerosol challenge with HDMA.
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Affiliation(s)
| | | | - Lisa A. Miller
- the Department of Pathology, Microbiology, and Immunology;†
| | | | | | | | | | | | - Alan R. Buckpitt
- and the California Regional Primate Research Center Exposure Facility,§
| | | | - Viviana J. Wong
- School of Veterinary Medicine; and the Department of Pediatrics,¶
| | - Jesse P. Joad
- School of Medicine, University of California, Davis, California
| | | | - Reen Wu
- the Department of Pathology, Microbiology, and Immunology;†
| | | | - Dallas M. Hyde
- the Department of Pathology, Microbiology, and Immunology;†
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Jagoda A, Shepherd SM, Spevitz A, Joseph MM. Refractory asthma, Part 1: Epidemiology, pathophysiology, pharmacologic interventions. Ann Emerg Med 1997; 29:262-74. [PMID: 9018193 DOI: 10.1016/s0196-0644(97)70278-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- A Jagoda
- Department of Emergency Medicine, Mount Sinai Medical Center, New York, New York, USA
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Szefler SJ, Bender BG, Jusko WJ, Lanier BQ, Lemanske RF, Skoner DP, Stempel DA. Evolving role of theophylline for treatment of chronic childhood asthma. J Pediatr 1995; 127:176-85. [PMID: 7636640 DOI: 10.1016/s0022-3476(95)70292-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- S J Szefler
- National Jewish Center for Immunology and Respiratory Medicine, Denver, CO 80206, USA
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Welty SE, Jarriel WS, Langston C, Hansen T. Pre mortem analysis of lung injury and lung function in oxygen toxic rabbits. Crit Care Med 1995; 23:340-7. [PMID: 7867358 DOI: 10.1097/00003246-199502000-00021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To determine whether respiratory system mechanics measurements could detect lung injury in oxygen toxic rabbits before clinical deterioration. To determine whether respiratory system mechanics measurements, using a power analysis, have the statistical power to detect significant reductions in hyperoxic lung injury due to an intervention when compared with traditional post mortem measurements of lung injury, extravascular lung water, and bronchoalveolar lavage protein concentration. DESIGN Prospective, controlled study. SETTING Institutional animal laboratories. SUBJECTS Adult New Zealand white rabbits. INTERVENTIONS Spontaneously breathing adult New Zealand white rabbits were exposed continuously to either > 95% oxygen or room air. MEASUREMENTS AND MAIN RESULTS We measured arterial pH, blood gas tensions, and respiratory system mechanics in rabbits twice, both before exposure to > 95% oxygen, and after the rabbits developed symptoms of mild lung dysfunction. After the second set of respiratory system mechanics measurements, we measured extravascular lung water and bronchoalveolar lavage protein concentration in the hyperoxia-exposed rabbits and compared the values with those values obtained in animals that breathed room air only. Our hyperoxia-exposed rabbits developed symptoms of mild respiratory impairment at 69 +/- 2 hrs. In these hyperoxia-exposed rabbits, measurements of static compliance, quasi-static compliance and resistance all changed significantly (p < .05) when compared with baseline measurements. Functional residual capacity and arterial blood gas values did not change significantly. Furthermore, assuming that an intervention reduced hyperoxic lung injury by a given amount, we performed a power analysis and found that the measurement of static compliance had at least equivalent power to detect a reduction in lung injury from an intervention when compared with measurement of extravascular lung water and bronchoalveolar lavage protein concentration. CONCLUSIONS Measurements of respiratory system mechanics can detect lung injury in hyperoxic rabbits before the onset of severe clinical deterioration or death. Furthermore, measurement of static compliance of the respiratory system is likely to be a powerful tool to detect a reduction in lung injury produced by an intervention.
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Affiliation(s)
- S E Welty
- Baylor College of Medicine Affiliated Hospitals, Houston, TX 77030
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Shrestha M, O'Brien T, Haddox R, Gourlay HS, Reed G. Decreased duration of emergency department treatment of chronic obstructive pulmonary disease exacerbations with the addition of ipratropium bromide to beta-agonist therapy. Ann Emerg Med 1991; 20:1206-9. [PMID: 1835324 DOI: 10.1016/s0196-0644(05)81472-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
STUDY OBJECTIVES To determine the benefit of the addition of ipratropium bromide to beta-agonist therapy of acute exacerbations of chronic obstructive pulmonary disease. DESIGN The trial was randomized and double blinded. SETTING The study was conducted in the emergency department of Parkland Memorial Hospital, a busy, inner-city, county hospital. INTERVENTIONS Patients were treated in the medicine emergency department with either the standard regimen of nebulized isoetharine, 0.5 mL of a 1% solution (5.0 mg) diluted to 2.0 mL with normal saline every hour (control group) or with the same regimen plus ipratropium bromide, 54 micrograms (three puffs) after the first isoetharine treatment and 36 micrograms (two puffs) after the second and fourth (experimental group). A placebo metered-dose inhaler used in the same manner as the ipratropium blinded the study to both the patients and medical personnel. MEASUREMENTS AND MAIN RESULTS The group treated with the addition of ipratropium (30) was discharged from the ED an average of 91 minutes (P less than .05) sooner than the control group (25) and required on the average one less isoetharine treatment (P less than .05). The pulmonary functions tested, forced expiratory volume in the first second, and the forced vital capacity were the same in the two groups initially and on discharge, as identical discharge criteria were used in each group. CONCLUSION The addition of ipratropium to standard beta-agonist treatment of chronic obstructive pulmonary disease exacerbations shortens the duration of treatment required in the ED.
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Affiliation(s)
- M Shrestha
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas 75235-8889
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Bleecker ER. Airways hyperreactivity, bronchial inflammation and obstructive lung disease. AGENTS AND ACTIONS. SUPPLEMENTS 1990; 30:73-86. [PMID: 2239543 DOI: 10.1007/978-3-0348-7488-5_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Understanding the mechanisms responsible for the development of chronic airflow obstruction is very important since this disease is the fifth leading cause of death in the United States and it produces a significant economic and social burden for society. Since reversal of established airflow obstruction is not possible, it would appear that the best prognosis and therapeutic results can be obtained by early diagnosis and prevention of irreversible disease. Understanding the underlying pathophysiologic mechanisms is necessary to detect susceptible individuals and develop effective interventions.
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Affiliation(s)
- E R Bleecker
- Department of Pulmonary and Critical Care Medicine, University of Maryland, School of Medicine, Baltimore
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