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Bhat AA, Gupta G, Goyal A, Thapa R, Almalki WH, Kazmi I, Alzarea SI, Kukreti N, Sekar M, Meenakshi DU, Singh SK, MacLoughlin R, Dua K. Unwinding circular RNA's role in inflammatory pulmonary diseases. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024; 397:2567-2588. [PMID: 37917370 DOI: 10.1007/s00210-023-02809-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 10/20/2023] [Indexed: 11/04/2023]
Abstract
Circular RNAs (circRNAs) have emerged as pivotal regulators of gene expression and cellular processes in various physiological and pathological conditions. In recent years, there has been a growing interest in investigating the role of circRNAs in inflammatory lung diseases, owing to their potential to modulate inflammation-associated pathways and contribute to disease pathogenesis. Inflammatory lung diseases, like asthma, chronic obstructive pulmonary disease (COPD), and COVID-19, pose significant global health challenges. The dysregulation of inflammatory responses demonstrates a pivotal function in advancing these diseases. CircRNAs have been identified as important players in regulating inflammation by functioning as miRNA sponges, engaging with RNA-binding proteins, and participating in intricate ceRNA networks. These interactions enable circRNAs to regulate the manifestation of key inflammatory genes and signaling pathways. Furthermore, emerging evidence suggests that specific circRNAs are differentially expressed in response to inflammatory stimuli and exhibit distinct patterns in various lung diseases. Their involvement in immune cell activation, cytokine production, and tissue remodeling processes underscores their possible capabilities as therapeutic targets and diagnostic biomarkers. Harnessing the knowledge of circRNA-mediated regulation in inflammatory lung diseases could lead to the development of innovative strategies for disease management and intervention. This review summarizes the current understanding of the role of circRNAs in inflammatory lung diseases, focusing on their regulatory mechanisms and functional implications.
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Affiliation(s)
- Asif Ahmad Bhat
- School of Pharmacy, Suresh Gyan Vihar University, Jagatpura 302017, Mahal Road, Jaipur, India
| | - Gaurav Gupta
- Centre for Global Health Research, Saveetha Medical College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, 602105, India.
| | - Ahsas Goyal
- Institute of Pharmaceutical Research, GLA University, Mathura, Uttar Pradesh, 281406, India
| | - Riya Thapa
- School of Pharmacy, Suresh Gyan Vihar University, Jagatpura 302017, Mahal Road, Jaipur, India
| | - Waleed Hassan Almalki
- Department of Pharmacology, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Imran Kazmi
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, 21589, Saudi Arabia
| | - Sami I Alzarea
- Department of Pharmacology, College of Pharmacy, Jouf University, Sakaka 72388, Al-Jouf, Saudi Arabia
| | - Neelima Kukreti
- School of Pharmacy, Graphic Era Hill University, Dehradun, 248007, India
| | - Mahendran Sekar
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia
| | | | - Sachin Kumar Singh
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, 144411, India
- Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, NSW, 2007, Australia
| | - Ronan MacLoughlin
- Research and Development, Aerogen Limited, IDA Business Park, Galway, Connacht, H91 HE94, Ireland
- School of Pharmacy & Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Leinster, D02 YN77, Ireland
- School of Pharmacy & Pharmaceutical Sciences, Trinity College, Dublin, Leinster, D02 PN40, Ireland
| | - Kamal Dua
- Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, NSW, 2007, Australia.
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW, 2007, Australia.
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Jha S, Chandi D. Recent Advances in the Devices for the Treatment of Chronic Obstructive Pulmonary Disease: A Review. Cureus 2023; 15:e49371. [PMID: 38146553 PMCID: PMC10749692 DOI: 10.7759/cureus.49371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 11/24/2023] [Indexed: 12/27/2023] Open
Abstract
Chronic obstructive pulmonary disease or COPD has been known to adversely affect people's quality of life. It influences a great number of individuals overall and is a main source of horribleness and mortality. It is associated with major healthcare and socioeconomic burdens. So, it is important to cure such types of diseases. This review article deals with the proper understanding of the newly developed devices and various advances taking place in the treatment of COPD. There are many new methods and procedures being developed recently for the cure or treatment of COPD, of which some are mentioned in the following review article. The articles also deal with the beneficial effects as well as the challenges faced during the use of those newly developed methods during the treatment of the disease. Various types of management of COPD are also mentioned in the article. This article also deals with the various new advances that are currently taking place in devices used in the therapy of COPD.
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Affiliation(s)
- Shivangi Jha
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Dhurba Chandi
- Microbiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Kebede AT, Trapnes E, Lea M, Abrahamsen B, Mathiesen L. Effect of pharmacist-led inhaler technique assessment service on readmissions in hospitalized COPD patients: a randomized, controlled pilot study. BMC Pulm Med 2022; 22:210. [PMID: 35624509 PMCID: PMC9145163 DOI: 10.1186/s12890-022-02004-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/13/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To investigate the effect of pharmacist-led inhaler technique assessment service on readmissions and CAT-score in hospitalized COPD patients. Furthermore, to provide an effect estimate for sample size calculations for future studies and to gain experience on the feasibility of such studies. METHODS A randomized controlled pilot study. Patients were randomized 1:1 to intervention or standard care. The primary endpoint was the difference in time to first readmission after hospital discharge between the treatment groups. RESULTS There was no statistically significant effect on the time to readmission (median 41 days in the intervention group (19 patients) and 95 days in the control group (20 patients), HR 1.74, 95% CI 0.81-3.75, p = 0.16). There was no statistically significant difference between the groups in CAT-score 2 months after discharge, median scores being 25.5 and 24 in the intervention and the control group, respectively (p = 0.29). There was, however, a reduction of 3.5 units in CAT-score from baseline to 2 months after discharge in the intervention group, compared to no change in the control group. CONCLUSION Pharmacist-led inhaler technique training had no effect on time to readmission or CAT-score. Future studies in larger populations should consider focusing on patients with less severe COPD, exploring CAT-score as a primary endpoint, consider stratifying for important baseline variables and evaluate the acceptability of the intervention. TRIAL REGISTRATION Date of registration 01/10/2018. CLINICALTRIALS gov identifier: NCT03691324.
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Affiliation(s)
- Adyam Tesfamariam Kebede
- Department of Pharmacy, Section for Pharmacology and Pharmaceutical Biosciences, University of Oslo, Oslo, Norway. .,Department of Pharmaceutical Services, Oslo Hospital Pharmacy, Hospital Pharmacies Enterprise, South-Eastern Norway, Oslo, Norway.
| | - Elin Trapnes
- Department of Pharmacy, Section for Pharmacology and Pharmaceutical Biosciences, University of Oslo, Oslo, Norway
| | - Marianne Lea
- Department of Pharmacy, Section for Pharmacology and Pharmaceutical Biosciences, University of Oslo, Oslo, Norway.,Department of Pharmaceutical Services, Oslo Hospital Pharmacy, Hospital Pharmacies Enterprise, South-Eastern Norway, Oslo, Norway
| | - Bjørg Abrahamsen
- Chief Physician at the Department of Pulmonary Medicine, Oslo University Hospital, Oslo, Norway
| | - Liv Mathiesen
- Department of Pharmacy, Section for Pharmacology and Pharmaceutical Biosciences, University of Oslo, Oslo, Norway
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Mitra S, Anand U, Ghorai M, Vellingiri B, Jha NK, Behl T, Kumar M, Radha, Shekhawat MS, Proćków J, Dey A. Unravelling the Therapeutic Potential of Botanicals Against Chronic Obstructive Pulmonary Disease (COPD): Molecular Insights and Future Perspectives. Front Pharmacol 2022; 13:824132. [PMID: 35645819 PMCID: PMC9130824 DOI: 10.3389/fphar.2022.824132] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/29/2022] [Indexed: 01/08/2023] Open
Abstract
Background: COPD (chronic obstructive pulmonary disease) is a serious health problem worldwide. Present treatments are insufficient and have severe side effects. There is a critical shortage of possible alternative treatments. Medicinal herbs are the most traditional and widely used therapy for treating a wide range of human illnesses around the world. In several countries, different plants are used to treat COPD. Purpose: In this review, we have discussed several known cellular and molecular components implicated in COPD and how plant-derived chemicals might modulate them. Methods: We have discussed how COVID-19 is associated with COPD mortality and severity along with the phytochemical roles of a few plants in the treatment of COPD. In addition, two tables have been included; the first summarizes different plants used for the treatment of COPD, and the second table consists of different kinds of phytochemicals extracted from plants, which are used to inhibit inflammation in the lungs. Conclusion: Various plants have been found to have medicinal properties against COPD. Many plant extracts and components may be used as novel disease-modifying drugs for lung inflammatory diseases.
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Affiliation(s)
- Sicon Mitra
- Department of Biotechnology, School of Engineering and Technology, Sharda University, Greater Noida, India
| | - Uttpal Anand
- CytoGene Research & Development LLP, Lucknow, Uttar Pradesh, India
| | - Mimosa Ghorai
- Department of Life Sciences, Presidency University, Kolkata, India
| | - Balachandar Vellingiri
- Human Molecular Cytogenetics and Stem Cell Laboratory, Department of Human Genetics and Molecular Biology, Bharathiar University, Coimbatore, India
| | - Niraj Kumar Jha
- Department of Biotechnology, School of Engineering and Technology, Sharda University, Greater Noida, India
| | - Tapan Behl
- Department of Pharmacology, Chitkara College of Pharmacy, Chitkara University, Chandigarh, India
| | - Manoj Kumar
- Chemical and Biochemical Processing Division, ICAR-Central Institute for Research on Cotton Technology, Mumbai, India
| | - Radha
- School of Biological and Environmental Sciences, Shoolini University of Biotechnology and Management Sciences, Solan, India
| | - Mahipal S. Shekhawat
- Department of Plant Biology and Biotechnology, Kanchi Mamunivar Government Institute for Postgraduate Studies and Research, Puducherry, India
| | - Jarosław Proćków
- Department of Plant Biology, Institute of Environmental Biology, Wrocław University of Environmental and Life Sciences, Wrocław, Poland
| | - Abhijit Dey
- Department of Life Sciences, Presidency University, Kolkata, India
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Ding Y, Sun L, Wang Y, Zhang J, Chen Y. Efficacy of ICS versus Non-ICS Combination Therapy in COPD: A Meta-Analysis of Randomised Controlled Trials. Int J Chron Obstruct Pulmon Dis 2022; 17:1051-1067. [PMID: 35547781 PMCID: PMC9084385 DOI: 10.2147/copd.s347588] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/24/2022] [Indexed: 12/15/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Yanling Ding
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, People’s Republic of China
| | - Lina Sun
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, People’s Republic of China
| | - Ying Wang
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, People’s Republic of China
| | - Jing Zhang
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, People’s Republic of China
- Correspondence: Jing Zhang; Yahong Chen, Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, People’s Republic of China, Tel +86 13-8104-57631, Email ;
| | - Yahong Chen
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, People’s Republic of China
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Bisserier M, Sun XQ, Fazal S, Turnbull IC, Bonnet S, Hadri L. Novel Insights into the Therapeutic Potential of Lung-Targeted Gene Transfer in the Most Common Respiratory Diseases. Cells 2022; 11:984. [PMID: 35326434 PMCID: PMC8947048 DOI: 10.3390/cells11060984] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 12/10/2022] Open
Abstract
Over the past decades, a better understanding of the genetic and molecular alterations underlying several respiratory diseases has encouraged the development of new therapeutic strategies. Gene therapy offers new therapeutic alternatives for inherited and acquired diseases by delivering exogenous genetic materials into cells or tissues to restore physiological protein expression and/or activity. In this review, we review (1) different types of viral and non-viral vectors as well as gene-editing techniques; and (2) the application of gene therapy for the treatment of respiratory diseases and disorders, including pulmonary arterial hypertension, idiopathic pulmonary fibrosis, cystic fibrosis, asthma, alpha-1 antitrypsin deficiency, chronic obstructive pulmonary disease, non-small-cell lung cancer, and COVID-19. Further, we also provide specific examples of lung-targeted therapies and discuss the major limitations of gene therapy.
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Affiliation(s)
- Malik Bisserier
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, New York, NY 10029, USA; (M.B.); (S.F.); (I.C.T.)
| | - Xiao-Qing Sun
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands;
| | - Shahood Fazal
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, New York, NY 10029, USA; (M.B.); (S.F.); (I.C.T.)
| | - Irene C. Turnbull
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, New York, NY 10029, USA; (M.B.); (S.F.); (I.C.T.)
| | - Sébastien Bonnet
- Pulmonary Hypertension Research Group, Québec Heart and Lung Institute Research Centre, Québec, QC G1V4G5, Canada;
- Department of Medicine, Laval University, Québec, QC G1V4G5, Canada
| | - Lahouaria Hadri
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, New York, NY 10029, USA; (M.B.); (S.F.); (I.C.T.)
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BICKTON FANUELMECKSON, Mankhokwe T, Mitengo M, Limbani F, Shannon H, Rylance J, Chisati E. “My life is not going to be the same, my health is going to improve”: a cross-sectional qualitative study of patients’ experiences of living with chronic respiratory symptoms and their views on a proposed pulmonary rehabilitation program at Queen Elizabeth Central Hospital, Blantyre, Malawi. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.17702.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Malawi’s population has a substantial burden of chronic respiratory symptoms. Elsewhere, patients with these symptoms have benefited from pulmonary rehabilitation (PR), a program of exercise training, education, and behaviour management. Practically, PR in Malawi may not be delivered in the same format as elsewhere due to substantial contextual differences. These differences necessitate adaptation of the intervention to Malawi’s setting to be acceptable and effective. This study explored patients’ experiences of living with chronic respiratory symptoms and their views on a proposed PR program at Queen Elizabeth Central Hospital, Blantyre, Malawi, to inform the design of an individualized and culturally adapted PR program. Methods: This was a cross-sectional qualitative study. Face-to-face, one-to-one semi-structured in-depth interviews were undertaken to data saturation. Interviews were audio-recorded, transcribed verbatim, and Chichewa transcripts were translated into English. The transcripts were anonymized and thematically analysed using an inductive approach. Results: We recruited 10 patients (five males and five females) with functionally limiting chronic respiratory symptoms, with documented causes including chronic obstructive pulmonary disease, asthma, post-tuberculosis lung disease, and bronchiectasis. Symptoms most frequently included dyspnoea, with associated functional limitations including the reduced performance of activities of daily living. Participants’ coping strategies most frequently included the use of inhalers. Participants were motivated to undertake the PR program owing to its anticipated benefits including improved health. They perceived transport costs and competing commitments as barriers to participation. The participant group gender mix and public nature of the program were considered socio-culturally sensitive by some participants. Conclusions: The functionally limiting dyspnoea most frequently experienced by the study participants would be amenable to a PR program. To ensure participation by eligible patients, pre-program assessments should consider patient access to transport, suitability of the timing for the program’s sessions, and patient views on organizational aspects of the program considered social-culturally sensitive.
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Lee SW, Park JJ, Lyu YR, Lee EJ, Kim SY, Kang W, Son JW, Jung IC, Park YC. The effect of lung-conduction exercise in chronic obstructive pulmonary disease: Randomized, assessor-blind, multicenter pilot trial. Medicine (Baltimore) 2022; 101:e28629. [PMID: 35060543 PMCID: PMC8772685 DOI: 10.1097/md.0000000000028629] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 12/28/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Pulmonary rehabilitation (PR) is a management modality that improves the quality of life of patients with chronic obstructive pulmonary disease (COPD); however, PR is not readily accessible. Therefore, we developed lung-conduction exercises (LCE) that can be performed easily without any limitations. The purpose of this randomized, assessor-blind, multicenter pilot trial was to compare the effects of LCE with PR and standard care (SC) in COPD patients. METHODS Twenty-five participants who met the eligibility criteria were randomly allocated to the SC group (only medication, n = 9), LCE group (medication + LCE, 5 times a week, n = 8), or PR group (medication + PR, 5 times a week, n = 8). The 6-minute walk distance (6WMD), pulmonary function test, modified Medical Research Council dyspnea scale, COPD assessment test (CAT), and St. George Respiratory Questionnaire (SGRQ) survey were carried out before starting the trial and after 4 and 8 weeks to determine motor performance, lung function, and dyspnea. RESULTS After 8 weeks, the pulmonary function test scores were the same. The 6MWD (PR, 28.3 ± 38.5; LCE, 14.5 ± 53.1; SC, 11.5 ± 20.5; P = .984), modified Medical Research Council dyspnea scale (PR, 0.8 ± 1.0; LCE, 0.8 ± 0.8; SC, 0.3 ± 0.5; P = .772), CAT (PR, 7.3 ± 6.2; LCE, 4.2 ± 5.2; SC, 1.0 ± 2.2; P = .232), and SGRQ scores (PR, 11.5 ± 15.4; LCE, 5.5 ± 13.1; SC, 4.8 ± 5.1; P = .358 [PR vs LCE], P = .795 [PR vs SC]) had improved in order of PR, LCE, and SC group. Although there were no statistically significant differences in the outcome measures between the groups, there were clinically significant improvements in the CAT and SGRQ scores. CONCLUSIONS In this trial, PR showed more improvement in symptoms and quality of life than SC alone. To seek a more precise use of LCE, further full-sized studies with a long duration and additional outcome measures such as psychological assessment tools and cost-effectiveness ratio should be conducted. TRIAL REGISTRATION KCT0004724.
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Affiliation(s)
- Su Won Lee
- Division of Respiratory Medicine, Department of Internal Medicine, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
| | - Jae Jun Park
- Division of Respiratory Medicine, Department of Internal Medicine, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
| | - Yee Ran Lyu
- Division of Respiratory Medicine, Department of Internal Medicine, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
- Clinical Trial Center, Daejeon Korean Medicine Hospital of Daejeon University, Daejeon, Republic of Korea
- Korea Institute of Oriental Medicine, Republic of Korea
| | - Eun Jung Lee
- Department of Rehabilitation Medicine of Korean Medicine, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
| | - Si Yeon Kim
- Clinical Trial Center, Daejeon Korean Medicine Hospital of Daejeon University, Daejeon, Republic of Korea
| | - Weechang Kang
- Department of Statistics, Hyehwa Liberal Arts College, Daejeon University, Daejeon, Republic of Korea
| | - Ji Woong Son
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Konyang University Hospital, Daejeon, Republic of Korea
| | - In Chul Jung
- Clinical Trial Center, Daejeon Korean Medicine Hospital of Daejeon University, Daejeon, Republic of Korea
- Department of Neuropsychology, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
| | - Yang Chun Park
- Division of Respiratory Medicine, Department of Internal Medicine, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
- Clinical Trial Center, Daejeon Korean Medicine Hospital of Daejeon University, Daejeon, Republic of Korea
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Yao W, Zhang X, Xu F, Cao C, Liu T, Xue Y. The therapeutic effects of naringenin on bronchial pneumonia in children. Pharmacol Res Perspect 2021; 9:e00825. [PMID: 34310866 PMCID: PMC8312741 DOI: 10.1002/prp2.825] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 05/29/2021] [Indexed: 01/28/2023] Open
Abstract
Bronchial pneumonia in children is a common infectious disease in toddlers and infants, which may cause hyperpyrexia, pulmonary moist rales, and even respiratory failure. Traditional drugs for bronchial pneumonia in children often lead to drug resistance and side effects. Recently, naringenin has been reported to be a potential treatment for several airway inflammatory diseases due to its anti-inflammatory and anti-microbial activities. The current clinical study aimed to evaluate the safety and therapeutic effect of naringenin in treating bronchial pneumonia in children. A total of 180 eligible patients were randomly assigned into naringenin (NAR) group and azithromycin (AZI) group. All participants were required to follow a 5-day oral administration, and their serum cytokine levels were measured during the clinical intervention. After the treatment, the disappearance time of clinical symptoms, and the incidences of complications and adverse reactions were compared between the two groups. Naringenin was able to inhibit inflammation, shorten the disappearance time of clinical symptoms, reduce the incidences of bronchial pneumonia complications and related adverse reactions, and improve the health conditions of the patients. Our results suggested that naringenin was safe and beneficial to children with bronchial pneumonia, providing new insights into the clinical application of naringenin.
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Affiliation(s)
- Wenjing Yao
- Department of PediatricsZibo Central HospitalZiboShandongChina
| | - Xiaopeng Zhang
- Department of PediatricsZibo Central HospitalZiboShandongChina
| | - Feng Xu
- Department of PediatricsZibo Central HospitalZiboShandongChina
| | - Chunxia Cao
- Department of PediatricsZibo Central HospitalZiboShandongChina
| | - Tongtong Liu
- Department of PediatricsZibo Central HospitalZiboShandongChina
| | - Yuanyuan Xue
- Department of PediatricsZibo Central HospitalZiboShandongChina
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Li M, Cheng K, Ku K, Li J, Hu H, Ung COL. Factors Influencing the Length of Hospital Stay Among Patients with Chronic Obstructive Pulmonary Disease (COPD) in Macao Population: A Retrospective Study of Inpatient Health Record. Int J Chron Obstruct Pulmon Dis 2021; 16:1677-1685. [PMID: 34135579 PMCID: PMC8200153 DOI: 10.2147/copd.s307164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/04/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose This study aims to identify the effects of patient and clinical therapy factors on the length of hospital stay (LOS) for admission due to chronic obstructive pulmonary disease (COPD) in Macao. Patients and Methods Health record of patients with COPD admitted to Kiang Wu Hospital from January 2017 to December 2019 was retrospectively analyzed. Demographic information, blood test results, clinical therapies, and LOS were described and analyzed by multivariable regression. Results A total of 1116 admissions were included with the average LOS being 12.28 (±9.23) days. Among them, 735 (66.6%) were male with mean age 79.42 (±10.35) years old, 697 were current or previous smokers (62.5%), and 360 (32.2%) had 3 or more comorbidities. During hospitalization, the most common treatments received were oxygen therapy (n=991,88.8%), antibiotics (n=828,74.2%), and systemic steroids (n=596,53.4%); only 120 (10.8%) had pulmonary rehabilitation (PR) and 128 (11.5%) received noninvasive ventilation (NIV). Inhaled medications were used during nearly 95% of hospitalization cases, while 2 and 3 types of inhaled medications were used during 230 (20.6%) and 582 (52.2%) hospitalization cases, respectively. Patient factors including age (B=0.178, 95% CI:0.535–1.072), being female (B=−1.147, 95% CI:-0.138–0.056), being current (B=−0.086, 95% CI:-0.124–0.018) or previous smoker (B=0.072, 95% CI:0.004–0.087), having 1, 2, 3 and over 3 comorbidities (B=0.126, 95% CI:0.034–0.147; B=0.125, 95% CI:0.031–0.144; B=0.116, 95% CI:0.028–0.146, B=0.090, 95% CI:0.021–0.166) and having low hemoglobin level (B=−0.118, 95% CI:-0.629- −0.214) exhibited significant associations with LOS. The use of NIV (B=0.080, 95% CI:0.022–0.138), pulmonary rehabilitation (B=0.269, 95% CI:0.212–0.327), two and three types of inhaled medications (B=0.109, 95% CI:0.003–0.166, B=0.255, 95% CI:0.083–0.237) were significantly associated with longer LOS (P<0.05). Conclusion NIV, PR and combined inhaled medications, which are often used for AECOPD, are the main clinical therapies associated with longer LOS in Macao. Smoking cessation, early treatments of comorbidities may be crucial to avoiding AECOPD and reducing LOS and disease burden.
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Affiliation(s)
- Meng Li
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao SAR, China
| | - Kun Cheng
- Internal Medicine Department, Kiang Wu Hospital, Macao SAR, China
| | - Keisun Ku
- Internal Medicine Department, Kiang Wu Hospital, Macao SAR, China
| | - Junlei Li
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao SAR, China
| | - Hao Hu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao SAR, China
| | - Carolina Oi Lam Ung
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao SAR, China
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Saba M, Davoodabadi A, Ghaffari A, Gilasi H, Haghpanah B. Combination adjunctive nebulized furosemide and salbutamol versus single agent therapy in COPD patients: A randomized controlled trial. Ann Med Surg (Lond) 2020; 57:85-90. [PMID: 32728436 PMCID: PMC7381425 DOI: 10.1016/j.amsu.2020.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/04/2020] [Accepted: 07/06/2020] [Indexed: 11/02/2022] Open
Abstract
Background COPD patients often require multiple therapies to enhance their lung function and reduce their symptoms in exacerbations. This study aimed to investigate the relative effects of combination adjunctive nebulized furosemide and salbutamol therapy versus single agent treatment in COPD patients. Methods Sixty-nine COPD patients were randomly divided into two groups. The first group (G1, 34 cases) received salbutamol in their first episode. The second group (G2, 35 cases) received furosemide in their first episode. Spirometry indices (FEV1, FVC, and FEV1/FVC), mMRC and BORG (COPD assessment) were assessed and recorded for all patients.To study the efficacy of combination adjunctive therapy, in 2nd episodes, the nebulized furosemide was added to nebulized salbutamol in the G1, and nebulized salbutamol was added to nebulized furosemide in G2. The aforementioned indices were then re-assessed. Results The mean age was (64.92 ± 11.71 years, 55% males. The use of nebulized furosemide and salbutamol as single agents slightly improved the spirometeric parameters, but it was not noteworthy compared to the significant improvement of the FEV1, FVC, FEV1/FVC, mMRC, and Borg parameters with combination therapy (p-value< 0.001). In the first episode, there was no difference in spirometeric indices, between groups (p-value > 0.1), so furosemide is considered as effective as nebulized salbutamol. Also, the results of sequential drugs administration, in the two groups was similar. Conclusion Conjunction of nebulized furosemide and salbutamol is more effective than single therapy and can be considered as preferred drug regimen without any reported side effect in the treatment of COPD.
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Affiliation(s)
| | | | - Azin Ghaffari
- Internal Medicine, Shahid Beheshti Hospital, Kashan, Iran
| | - Hamidreza Gilasi
- Departments of Epidemiology & Biostatistics, Kashan University of Medical Sciences, Kashan, Iran
| | - Babak Haghpanah
- Orthopedic Surgery, Kashan University of Medical Sciences, Kashan, Iran
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Vu GV, Ha GH, Nguyen CT, Vu GT, Pham HQ, Latkin CA, Tran BX, Ho RCM, Ho CSH. Interventions to Improve the Quality of Life of Patients with Chronic Obstructive Pulmonary Disease: A Global Mapping During 1990-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3089. [PMID: 32365510 PMCID: PMC7246922 DOI: 10.3390/ijerph17093089] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 12/31/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) has been considered a significant health challenge globally in recent years, which affects different aspects of the quality-of-life (QoL). A review was conducted of research output, research topics, and landscape to have a global view of the papers mentioning the interventions to increase QoL of patients with COPD. A total of 3242 research items from Web of Science during the period 1990-2018 were downloaded and analyzed. Analyses based on the different levels of data and methods using using VOSviewer software tool (version 1.16.15, Centre for Science and Technology Studies (CWTS), Leiden University, Leiden, The Netherlands) and Latent Dirichlet allocation. By exploring the trends in research productivity and topics, an increase was found in the number of papers mentioning non-pharmacological interventions as well as mental health illness and QoL among patients with COPD. In conclusion, the research on the interventions to increase the QoL of patients with COPD has attracted scientists globally. It is suggested that more research should be conducted on the effectiveness of non-pharmacological therapies to increase QoL of patients with COPD that can be applied broadly in the community. The collaboration and support from developed countries to developing countries are needed to increase the QoL of people living with COPD.
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Affiliation(s)
- Giap Van Vu
- Department of Internal Medicine, Hanoi Medical University, Hanoi 100000, Vietnam
- Respiratory Center, Bach Mai Hospital, Hanoi 100000, Vietnam
| | - Giang Hai Ha
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam
- Faculty of Pharmacy, Duy Tan University, Da Nang 550000, Vietnam
| | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam
- Faculty of Medicine, Duy Tan University, Da Nang 550000, Vietnam
| | - Giang Thu Vu
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam
| | - Hai Quang Pham
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam
| | - Carl A. Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Roger C. M. Ho
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore 119077, Singapore
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam
| | - Cyrus S. H. Ho
- Department of Psychological Medicine, National University Hospital, Singapore 119074, Singapore
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Imagita H, Nishii Y, Fujita N, Sukedzane T, Kawata S. Effects of appropriate-intensity treadmill exercise on skeletal muscle and respiratory functions in a rat model of emphysema. Biomed Res 2020; 41:13-22. [PMID: 32092736 DOI: 10.2220/biomedres.41.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The number of patients with chronic obstructive pulmonary disease (COPD), a typical respiratory disorder, is rapidly increasing globally. The purpose of this study was to determine the effects of appropriate-intensity treadmill exercise on skeletal muscle and respiratory functions in a rat model of emphysema. Twenty-one Wistar rats were randomly divided into three groups: the sham (SH) group, pulmonary emphysema (PE) group, and emphysema + exercise (EX) group. Cigarette smoke solution and lipopolysaccharide were intratracheally administered for 4 weeks in the PE and EX groups. The rats in the EX group were made to run on treadmills in the latter 2 weeks of the experiment. Lung tissue was stained with anti-macrophage antibodies; the specific force (contractile force per unit cross-sectional area) of the diaphragm and hind-limb muscles was measured, and blood was analyzed for serum cytokine levels. Many macrophages were observed in the lung tissue of the PE group. In the EX group, the population of macrophages was smaller, and the specific force of the diaphragm and extensor digitorum longus muscles was higher than in the PE group. Moreover, the degree of inflammation in the pulmonary tissue was reduced in the EX group. These results suggest that adaptive exercise may improve not only respiratory and muscle functions but also inflammation of the pulmonary tissue associated with emphysema.
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Affiliation(s)
| | - Yasue Nishii
- Graduate School of Health Sciences, Kio University
| | - Naoto Fujita
- Graduate School of Health Sciences, Hiroshima University
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14
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Baral MA. Knowledge and practice of dry powder inhalation among patients with chronic obstructive pulmonary disease in a regional hospital, Nepal. Int J Gen Med 2018; 12:31-37. [PMID: 30636890 PMCID: PMC6307686 DOI: 10.2147/ijgm.s165659] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Dry powder inhalation is a cornerstone of treatment in patients with COPD. This study was undertaken to study the knowledge and practice of dry powder inhalation among such patients. Patients and methods The current study was a cross-sectional study conducted in Western Regional Hospital, Pokhara, Nepal. The study was conducted among 204 COPD patients (outpatients and inpatients) aged ≥20 years who had been using rotahaler, a dry powder inhaler device, and a purposive sampling technique was used. Data were collected from February 28, 2016, to March 26, 2016. A questionnaire was administered by the interviewer to assess the knowledge about dry powder inhaler (DPI) and inhalation while a Dutch Asthma Foundation observation checklist for rotahaler was used to evaluate the practice of dry powder inhalation. The collected data were analyzed using descriptive statistics and inferential statistics (chi-square test). Results Findings from the study showed that a low proportion of the respondents had accurate knowledge and correctly practiced inhalation technique (3.9%). However, majority of the respondents (77.5%) performed the critical steps correctly. The correct practice of dry powder inhalation was associated with younger age (p=0.008), urban residence (p=0.024), and literacy (p=0.012). The practice was comparatively more accurate among those who received practical classes/demonstration on the inhalation technique from health care providers (p<0.001). Conclusion Based on the study findings, it was concluded that COPD patients attending Western Regional Hospital possessed satisfactory knowledge but poor technique of dry powder inhalation. The most important modifiable factor for incorrect practice was a lack of demonstration on inhalation technique by the health care provider. Therefore, it is necessary for health care providers to supplement verbal instruction on dry powder inhalation with demonstration and re-demonstration from the patients to improve the knowledge and practice of dry powder inhalation for COPD patients.
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Affiliation(s)
- Mira Adhikari Baral
- Department of Nursing, Pokhara Campus, Tribhuvan University, Institute of Medicine, Pokhara, Nepal,
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Izquierdo JL, Cosio BG. The dose of inhaled corticosteroids in patients with COPD: when less is better. Int J Chron Obstruct Pulmon Dis 2018; 13:3539-3547. [PMID: 30498343 PMCID: PMC6207269 DOI: 10.2147/copd.s175047] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background The use of inhaled corticosteroids (ICS) in combination with bronchodilators in patients with COPD has been shown to decrease the rate of disease exacerbations and to improve the lung function and patients’ quality of life. However, their use has also been associated with an increased risk of pneumonia. Materials and methods We have reviewed existing clinical evidence on the risks and benefits of ICS in COPD, including large randomized clinical trials, meta-analyses, and clinical reviews. Results A large body of evidence supports the clinical benefits of ICS in patients with COPD in terms of exacerbations, symptoms, lung function, and quality of life. The incidence of adverse events related to ICS, including pneumonia, varies strongly among the studies and seems to be dose dependent, with recent well-designed, large studies on low-dose ICS reporting similar safety profiles in ICS and non-ICS groups. Conclusion The benefits of ICS in COPD continue to outweigh the risks, especially when lower ICS doses are employed. Given that the data on ICS withdrawal in COPD are scarce and conflicting, we argue that using reduced doses of ICS could be an optimal strategy to manage patients with COPD.
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Affiliation(s)
- José Luis Izquierdo
- Department of Pneumology and Medicine, Hospital Universitario, Universidad de Alcalá, Guadalajara, Spain,
| | - Borja G Cosio
- Department of Respiratory Medicine, Hospital Son Espases-IdISBa, Palma de Mallorca, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
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16
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Proteases and Their Inhibitors in Chronic Obstructive Pulmonary Disease. J Clin Med 2018; 7:jcm7090244. [PMID: 30154365 PMCID: PMC6162857 DOI: 10.3390/jcm7090244] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 08/24/2018] [Accepted: 08/25/2018] [Indexed: 12/21/2022] Open
Abstract
In the context of respiratory disease, chronic obstructive pulmonary disease (COPD) is the leading cause of mortality worldwide. Despite much development in the area of drug development, currently there are no effective medicines available for the treatment of this disease. An imbalance in the protease: Antiprotease ratio in the COPD lung remains an important aspect of COPD pathophysiology and several studies have shown the efficacy of antiprotease therapy in both in vitro and in vivo COPD models. However more in-depth studies will be required to validate the efficacy of lead drug molecules targeting these proteases. This review discusses the current status of protease-directed drugs used for treating COPD and explores the future prospects of utilizing the potential of antiprotease-based therapeutics as a treatment for this disease.
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Ferguson GT, Kerwin EM, Donohue JF, Ganapathy V, Tosiello RL, Bollu VK, Rajagopalan K. Health-Related Quality of Life Improvements in Moderate to Very Severe Chronic Obstructive Pulmonary Disease Patients on Nebulized Glycopyrrolate: Evidence from the GOLDEN Studies. CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2018; 5:193-207. [PMID: 30584583 DOI: 10.15326/jcopdf.5.3.2017.0178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background: Symptoms of chronic obstructive pulmonary disease (COPD) may diminish patients' health-related quality of life (HRQoL). We report effects of Longhala™ Magnair™ (glycopyrrolate) Inhalation Solution, a drug/device combination of the long-acting antimuscarinic glycopyrrolate administered using the eFlow® closed system (eFlow CS) nebulizer, on HRQoL from the Glycopyrrolate for Obstructive Lung Disease Via Electronic Nebulizer (GOLDEN) clinical studies. Methods: Data consisted of a pooled analysis of 2 phase 3, 12-week efficacy studies (GOLDEN-3 and -4) of glycopyrrolate/eFlow CS (25 or 50 mcg twice daily [BID]) versus placebo, and a 48-week, open-label safety study (GOLDEN-5) of glycopyrrolate/eFlow CS 50 mcg BID versus tiotropium 18 mcg once daily in patients with moderate to very severe COPD. Change from baseline in HRQoL was measured via the St George's Respiratory Questionnaire (SGRQ). Results are provided as mean changes in SGRQ Total score and as response analysis (≥4-point improvement [responder], no change, and ≥4-point worsening in Total score) using analysis of covariance or logistic regression, as applicable. Results: Atotal of 1293 patients were evaluated from GOLDEN-3 and -4 and 1086 from GOLDEN-5. Glycopyrrolate/eFlow CS significantly improved SGRQ Total and component scores. The percentage of SGRQ responders in pooled GOLDEN-3/4 was 46.8% for glycopyrrolate/eFlow CS 25 mcg, 41.7% for glycopyrrolate/eFlow CS 50 mcg, and 34.5% for placebo. SGRQ Total and component score improvements were similar between glycopyrrolate/eFlow CS and tiotropium in GOLDEN-5. Conclusions: The drug/device combination of glycopyrrolate/eFlow CS significantly improved HRQoL, as measured by the SGRQ, offering a potential maintenance treatment option in patients with moderate to very severe COPD. ClinicalTrials.gov: NCT02347761, NCT02347774, NCT02276222.
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Affiliation(s)
- Gary T Ferguson
- Pulmonary Research Institute of Southeast Michigan, Farmington Hills
| | | | - James F Donohue
- University of North Carolina School of Medicine, Chapel Hill
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Monaco TJ, Hanania NA. Emerging inhaled long-acting beta-2 adrenoceptor agonists for the treatment of COPD. Expert Opin Emerg Drugs 2017; 22:285-299. [DOI: 10.1080/14728214.2017.1367382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Thomas J. Monaco
- Baylor College of Medicine, Section of Pulmonary and Critical Care Medicine, Houston, TX, USA
| | - Nicola A. Hanania
- Baylor College of Medicine, Section of Pulmonary and Critical Care Medicine, Houston, TX, USA
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Kabbach EZ, Mazzuco A, Borghi-Silva A, Cabiddu R, Agnoleto AG, Barbosa JF, de Carvalho Junior LCS, Mendes RG. Increased parasympathetic cardiac modulation in patients with acute exacerbation of COPD: how should we interpret it? Int J Chron Obstruct Pulmon Dis 2017; 12:2221-2230. [PMID: 28814850 PMCID: PMC5546179 DOI: 10.2147/copd.s134498] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Cardiac autonomic modulation (CAM) is impaired in patients with stable COPD. Exacerbation aggravates the patients’ health status and functional capacity. While the clinical and functional effects of exacerbation are known, no studies investigated CAM during exacerbation and whether there is a relationship between CAM and functional capacity and dyspnea. Methods Thirty-two patients with moderate to severe COPD were enrolled into two groups: stable COPD (GSta, n=16) and acute exacerbation of COPD (GAE, n=16). The GAE patients were evaluated 24–48 hours after starting standard therapy for COPD exacerbation during hospitalization; the GSta patients were evaluated in an outpatient clinic and included in the study if no decompensation episodes had occurred during the previous month. The heart rate (HR) and R-wave peak detection intervals in ms (RRi) were registered using a heart rate monitor (Polar® system) at rest in seated position during 10 minutes. CAM was assessed by heart rate variability (HRV) linear and non-linear analysis. Functional capacity was evaluated by handgrip strength test, performed by Jamar® dynamometer, and dyspnea was scored using the modified scale of the Medical Research Council. Results GAE presented higher parasympathetic CAM values compared with GSta for square root of the mean squared differences of successive RRi (RMSSD; 17.8±5.6 ms vs 11.7±9.5 ms); high frequency (HF; 111.3±74.9 ms2 vs 45.6±80.7 ms2) and standard deviation measuring the dispersion of points in the plot perpendicular to the line of identity (SD1; 12.7±3.9 ms vs 8.3±6.7 ms) and higher CAM values for standard deviation of the mean of all of RRi (STD RRi; 19.3±6.5 ms vs 14.3±12.5 ms); RRi tri (5.2±1.7 ms vs 4.0±3.0 ms); triangular interpolation of NN interval histogram (TINN; 88.7±26.9 ms vs 70.6±62.2 ms); low frequency (LF; 203±210.7 ms2 vs 101.8±169.7 ms2) and standard deviation measuring the dispersion of points along the line of identity (SD2; 30.4±14.8 ms vs 16.2±12.54 ms). Lower values were observed for the complexity indices: approximate entropy (ApEn; 0.9±0.07 vs 1.06±0.06) and sample entropy (SampEn; 1.4±0.3 vs 1.7±0.3). Significant and moderate associations were observed between HF (nu) and handgrip strength (r=−0.58; P=0.01) and between LF (ms2) and subjective perception of dyspnea (r=−0.53; P=0.03). Conclusion COPD exacerbated patients have higher parasympathetic CAM than stable patients. This should be interpreted with caution since vagal influence on the airways determines a narrowing and not a better clinical condition. Additionally, functional capacity was negatively associated with parasympathetic CAM in COPD exacerbation.
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Affiliation(s)
- Erika Zavaglia Kabbach
- Department of Physical Therapy, Cardiopulmonary Physiotherapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Sao Paulo, Brazil
| | - Adriana Mazzuco
- Department of Physical Therapy, Cardiopulmonary Physiotherapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Sao Paulo, Brazil
| | - Audrey Borghi-Silva
- Department of Physical Therapy, Cardiopulmonary Physiotherapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Sao Paulo, Brazil
| | - Ramona Cabiddu
- Department of Physical Therapy, Cardiopulmonary Physiotherapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Sao Paulo, Brazil
| | - Aline Galvão Agnoleto
- Department of Physical Therapy, Cardiopulmonary Physiotherapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Sao Paulo, Brazil
| | - Jessica Fernanda Barbosa
- Department of Physical Therapy, Cardiopulmonary Physiotherapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Sao Paulo, Brazil
| | | | - Renata Gonçalves Mendes
- Department of Physical Therapy, Cardiopulmonary Physiotherapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Sao Paulo, Brazil
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Pejic R, Klaric B. Transient anisocoria in a patient treated with nebulized ipratropium bromide. Am J Ophthalmol Case Rep 2017; 7:11-13. [PMID: 29260071 PMCID: PMC5722162 DOI: 10.1016/j.ajoc.2017.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 04/10/2017] [Indexed: 11/19/2022] Open
Abstract
Purpose We present a case report of a 44-year old female patient with complicated pneumonia who developed anisocoria after treatment with inhaled ipratropium bromide. Discontinuation of ipratropium bromide treatment led to complete resolution of anisocoria. Observation A 44-year old female patient was admitted to the Department of Pulmonology due to high body temperature (40.0 °C), coughing and general weakness. After a general examination and tests the patient was diagnosed with right-sided pneumonia. Since spirometry test showed signs of bronchial obstruction, pulmonologist indicated inhalation therapy with ipratropium bromide. Soon after ipratropium bromide therapy was initiated, the patient noticed enlarged left pupil and stated that some aerosol reached her left eye during the inhalation therapy. After consulting neurology and monitoring neurological signs, ipratropium bromide treatment was discontinued. Twenty-four hours after discontinuing the ipratropium bromide treatment anisocoria was completely resolved. Conclusions and importance Presence of anisocoria may be a concerning neurological sign. If there are no other neurological or ophthalmological signs and symptoms and a recent ipratropium bromide inhalation treatment exists in the patient's history, we should consider iatrogenic side-effect of drugs as a possible reason of anisocoria and possibly spare the patient extensive and invasive diagnostic procedures that can also raise costs of treatment significantly. Observing neurological status and testing with 1% pilocarpine solution may be necessary to determine the etiology of this condition.
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Affiliation(s)
- Renato Pejic
- Department of Ophthalmology, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
- Corresponding author. Splitska 66, 88 000 Mostar, Bosnia and Herzegovina.Splitska 66Mostar88 000Bosnia and Herzegovina
| | - Branka Klaric
- Department of Pulmonology, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
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Brandt C, Thronicke A, Roehmel JF, Krannich A, Staab D, Schwarz C. Impact of Long-Term Tiotropium Bromide Therapy on Annual Lung Function Decline in Adult Patients with Cystic Fibrosis. PLoS One 2016; 11:e0158193. [PMID: 27351829 PMCID: PMC4924629 DOI: 10.1371/journal.pone.0158193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 06/13/2016] [Indexed: 01/01/2023] Open
Abstract
Background Chronic lung disease is the leading cause of death in patients with Cystic Fibrosis (CF) and is often treated with bronchodilators. It is not known whether long-term tiotropium bromide treatment may have a positive impact on lung function. Methods This retrospective cohort study estimated annual lung function decline utilizing longitudinal data for forced expiratory volume in 1 s (FEV1). Results A total of 160 adult patients with CF were analyzed. The subjects treated for 24 months with tiotropium bromide had a significantly slower decline of mean annual change of FEV1 (treated: -0.3±4.0%; control: -2.3±5.0%; p = 0.0130). In patients with FEV1 ≥70% predicted, long-term tiotropium bromide treatment was associated with greater improvements in annual lung function decline (FEV1 ≥70% predicted: treated: +0.5±4.7%; control: -4.0±6.3%; p = 0.0132; FEV1 50–69% predicted: treated: -0.5±4.4%; control: -0.8±3.8%; p = 0.7142; FEV1 ≤49% predicted: treated: -0.6±3.4%; control: -2.4±4.8%; p = 0.0898). Conclusion This study suggests that long-term tiotropium bromide treatment may be associated with reduced annual decline of FEV1 in patients with CF, particularly in adults with a mild degree of severity.
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Affiliation(s)
- Claudia Brandt
- Department of Pediatric Pneumology and Immunology, Cystic Fibrosis Center / Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Anja Thronicke
- Department of Pediatric Pneumology and Immunology, Cystic Fibrosis Center / Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Jobst F. Roehmel
- Department of Pediatric Pneumology and Immunology, Cystic Fibrosis Center / Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Alexander Krannich
- Biostatistics Unit, Berlin Institute of Health, Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Doris Staab
- Department of Pediatric Pneumology and Immunology, Cystic Fibrosis Center / Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Carsten Schwarz
- Department of Pediatric Pneumology and Immunology, Cystic Fibrosis Center / Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- * E-mail:
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Doherty E, Oaks Z, Perl A. Increased mitochondrial electron transport chain activity at complex I is regulated by N-acetylcysteine in lymphocytes of patients with systemic lupus erythematosus. Antioxid Redox Signal 2014; 21:56-65. [PMID: 24673154 PMCID: PMC4048573 DOI: 10.1089/ars.2013.5702] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIMS Systemic lupus erythematosus (SLE) patients' peripheral blood lymphocytes (PBL) show mitochondrial dysfunction and oxidative stress. To determine the electrochemical bases of mitochondrial dysfunction, we measured electron transport chain (ETC) activity and its regulation by N-acetylcysteine (NAC) that reversed glutathione depletion and improved disease activity in SLE. ETC activity was assessed in PBL of 69 SLE patients and 37 healthy donors. Negatively isolated T cells were examined in 7 SLE patients, 11 healthy donors, and 10 nonlupus inflammatory arthritis (IA) donors. RESULTS O₂ consumption (in nmol/ml/min) by lupus PBL was increased at baseline (SLE: 2.492±0.196, control: 2.137±0.153; p=0.027) and with complex IV substrates (SLE: 7.722±0.419, control: 7.006±0.505; p=0.028). SLE PBL consumed more O₂ upon in-chamber T-cell activation (p=0.012). After overnight T-cell stimulation, ETC activity of SLE PBL was 2.27-fold increased through complex I (SLE: 1.606±0.273, control: 0.709±0.169; p=0.001) and, to a lesser extent, through complex IV. Likewise, complex I activity was elevated in negatively isolated "untouched" T cells of SLE patients (1.816±0.180) relative to healthy controls (0.917±0.094; p=0.0003) and IA disease controls studied in parallel (1.057±0.199; p=0.0308). NAC diminished O₂ consumption through complex I and H₂O₂ levels both in SLE and in control PBL. INNOVATION O₂ consumption was found to be increased in SLE patients' PBL relative to control subjects evaluated in parallel. ETC complex I is identified as the main source of oxidative stress in SLE. CONCLUSIONS Lupus PBL exhibit increased O₂ consumption through mitochondrial ETC complex I that is inhibited by NAC, which may have therapeutic efficacy through reducing oxidative stress in SLE.
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Affiliation(s)
- Edward Doherty
- 1 Division of Rheumatology, Department of Medicine, College of Medicine, State University of New York , Upstate Medical University, Syracuse, New York
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Polosa R, Malerba M, Cacciola RR, Morjaria JB, Maugeri C, Prosperini G, Gullo R, Spicuzza L, Radaeli A, Di Maria GU. Effect of acute exacerbations on circulating endothelial, clotting and fibrinolytic markers in COPD patients. Intern Emerg Med 2013; 8:567-74. [PMID: 21660493 DOI: 10.1007/s11739-011-0636-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2011] [Accepted: 05/20/2011] [Indexed: 10/18/2022]
Abstract
Patients with chronic obstructive pulmonary disease (COPD) are prone to clinical exacerbations that are associated with increased airway inflammation, a potent pro-thrombotic stimulus. Limited information is available on the mechanisms underlying the putative alterations of the endothelial-coagulative system during acute exacerbations. The aim was to investigate whether the activation of the endothelial-coagulative system occurs in association with the acute inflammatory response of COPD exacerbation. We monitored the blood levels of surrogate markers of inflammation: interleukin-6 (IL-6); endothelium damage: von Willebrand's factor (vWF); clotting activation: D-dimer (D-D), and prothrombin fragment 1+2 (F1+2); fibrinolytic response: plasminogen activator inhibitor 1 (PAI-1), in COPD subjects, during hospital admission and after clinical resolution. In 30 COPD subjects, IL-6, vWF, D-D and F1+2 levels were elevated during exacerbation and decreased significantly at clinical stability (IL-6, p = 0.005; vWF, p < 0.001; D-D, p < 0.001; F1+2, p < 0.001). PAI-1 levels did not change at exacerbation compared to clinically stable situations. Positive correlations were observed between several of the markers measured. Elevation of IL-6, vWF, D-D and F1+2 levels during COPD exacerbations implies a strict association between acute inflammation, endothelial activation and clotting initiation. This was not associated with a change in PAI-1, implying an increase in the fibrinolytic response to inflammation. The pro-thrombotic nature of COPD exacerbations sustained by enhanced clotting activation appears to be mitigated by excessive fibrinolysis.
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Affiliation(s)
- Riccardo Polosa
- Dipartimento di Medicina Interna e Specialistica, Università di Catania, Catania, Italy,
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Colthorpe P, Voshaar T, Kieckbusch T, Cuoghi E, Jauernig J. Delivery characteristics of a low-resistance dry-powder inhaler used to deliver the long-acting muscarinic antagonist glycopyrronium. J Drug Assess 2013; 2:11-6. [PMID: 27536432 PMCID: PMC4937662 DOI: 10.3109/21556660.2013.766197] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2013] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The long-acting muscarinic antagonist (LAMA) glycopyrronium (NVA237) has recently been approved as a once-daily treatment for COPD. The objectives of this study were to determine the dose delivery characteristics of glycopyrronium and compare them with those of the LAMA tiotropium, both delivered by their respective capsule-based dry-powder inhalers (DPIs). RESEARCH DESIGN AND METHODS Seven inhalation profiles derived from patients with moderate and severe COPD were reproduced to determine the aerodynamic particle size distribution of glycopyrronium delivered by the Breezhaler device, a low-resistance DPI†. Theoretical respiratory tract deposition was estimated using a semi-empirical model for healthy lungs. These results were compared with those of tiotropium delivered by the high-resistance HandiHaler‡ device obtained in a previous study using the same set of inhalation profiles. Study limitations are that fine particle fraction (FPF) and particle size are generated by the inhalers are not a direct measure of lung deposition, and the bronchodilator effect of inhaled drugs does not depend solely upon the percentage of the total dose that reaches the lung. RESULTS The mean FPF (≤4.7 µm) was 42.6% of the nominal dose (which refers to the content of the capsule) for glycopyrronium and 9.8% for tiotropium while the mass median aerodynamic diameter (MMAD) was 2.8 µm and 3.9 µm for glycopyrronium and tiotropium, respectively. The mean estimated intrathoracic drug deposition as a percentage of the mean dose delivered to the Next Generation Impactor was 39% for glycopyrronium and 22% for tiotropium. CONCLUSIONS The glycopyrronium capsule-based DPI delivered a higher FPF and greater and more consistent intrathoracic deposition irrespective of age and disease severity compared to the tiotropium capsule-based DPI, suggesting that it may be suitable for use by patients with a wide range of COPD severities.
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Affiliation(s)
| | - Thomas Voshaar
- Krankenhaus Bethanien, Moers, IMS Health FrankfurtGermany
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Malerba M, Radaeli A, Morjaria JB. Therapeutic potential for novel ultra long-acting β2-agonists in the management of COPD: biological and pharmacological aspects. Drug Discov Today 2011; 17:496-504. [PMID: 22119310 DOI: 10.1016/j.drudis.2011.11.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 10/13/2011] [Accepted: 11/10/2011] [Indexed: 01/08/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is characterised by progressive airflow limitation. In moderate-to-severe COPD, long-acting bronchodilators are the basis of therapy. Inhaled long-acting β(2)-agonists (LABAs) are used for the treatment of COPD. LABAs have been in use since the 1990s enabling persistent bronchodilation for 12 hours; however, sustained bronchodilation is desirable. Compared with twice-daily LABAs, new LABAs with ultra-long duration (ultra-LABAs) could provide improvements in efficacy and compliance with fast onset of action, 24-hour bronchodilation and a good safety profile. Several novel ultra-LABAs showing once-daily delivery profiles are in development. In this article, we discuss these novel agents' properties and clinical trials of their efficacy and safety, including the only licensed ultra-LABA, indacaterol.
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Affiliation(s)
- Mario Malerba
- Department of Internal Medicine, University of Brescia, 1st Divisione di Medicina, Az Spedali Civili, Pzza Spedali Civili 1, 25100 Brescia, Italy.
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Larocca NE, Moreno D, Garmendia JV, De Sanctis JB. New pharmacological treatments for patients with chronic obstructive pulmonary disease (COPD). Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2011; 155:43-50. [PMID: 21475377 DOI: 10.5507/bp.2011.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable disease characterized mainly by pulmonary airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with abnormal inflammatory response of the lung to noxious particles or gasses. New different pharmacological approaches to decrease inflammation of the airways and consequently disease progression and increase airway obstruction reversibility have been developed. METHODS AND RESULTS A literature search using PubMed, Science Direct, EBSCO and free patents on line for the years 2000-2010. CONCLUSIONS Recent discoveries in the physiology and pathology of airways diseases have served to generate potential new drugs for the treatment of COPD patients. Several substances that block or activate specific pathways and receptors the aim of which is to decrease inflammation and increase airway obstruction reversibility are being used in different clinical protocols and hopefully will be available for patients in the near future.
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Affiliation(s)
- Nancy Elizabeth Larocca
- Department of Pathology and Physiopathology, Experimental Medicine Institute, Faculty of Medicine, Universidad Central de Venezuela, Venezuela
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