ABSTRACT
Patients with neuromuscular diseases (NMD) can present to the neurologist with symptoms and signs of respiratory failure, either acutely or as an insidious process in the outpatient setting. Since the advent of non-invasive ventilation, the outcomes of patients with ventilatory failure due to NMD have dramatically improved. However, the natural history of different NMDs requires a nuanced approach to respiratory investigation and management. Respiratory failure dictates the prognosis of many NMDs and timing the most appropriate investigation and referral to ventilation services is crucial in optimising care.
Subject(s)
Neuromuscular Diseases , Noninvasive Ventilation , Respiratory Insufficiency , Humans , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , Prognosis , Chronic Disease , Neuromuscular Diseases/complications , Neuromuscular Diseases/diagnosis , Neuromuscular Diseases/therapyABSTRACT
Blood eosinophils are a predictive biomarker of inhaled corticosteroid response in chronic obstructive pulmonary disease (COPD). We investigated blood eosinophil stability over 1 year using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2019 thresholds of < 100, 100- < 300 and ≥ 300 eosinophils/µL in 225 patients from the COPDMAP cohort. Blood eosinophils showed good stability (rho: 0.71, p < 0.001, ICC 0.84), and 69.3% of patients remained in the same eosinophil category at 1 year. 85.3% of patients with eosinophils < 100 cells/µL had stable counts. The majority of blood eosinophil counts remain stable over 1 year using the GOLD 2019 thresholds.
Subject(s)
Bronchodilator Agents/administration & dosage , Eosinophils/metabolism , Pulmonary Disease, Chronic Obstructive/blood , Pulmonary Disease, Chronic Obstructive/drug therapy , Administration, Inhalation , Aged , Eosinophils/drug effects , Female , Humans , Leukocyte Count/methods , Male , Middle Aged , Pulmonary Disease, Chronic Obstructive/diagnosisABSTRACT
PURPOSE OF REVIEW: Small airway disease (SAD) is a common feature in chronic obstructive pulmonary disease (COPD) patients. Chronic exposure to cigarette smoking causes inflammation, damage, tissue remodelling and eventually airway loss. These features lead to airflow limitation and defective alveolar ventilation. The aim of this review is to provide clinicians with an up-to-date perspective of SAD in COPD. RECENT FINDINGS: In this review, we will discuss the key pathological features of SAD. We also review state-of-the-art techniques for measuring SAD, including impulse oscillometry and lung imaging methods. We discuss emerging concepts such as SAD in the earlier stages of COPD and the relationship between SAD and emphysema. SUMMARY: The current review highlights the importance of targeting small airways early in the course of COPD to tackle disease progression.
Subject(s)
Bronchioles , Lung , Pulmonary Disease, Chronic Obstructive , Bronchioles/pathology , Bronchioles/physiopathology , Disease Progression , Early Medical Intervention/methods , Humans , Lung/diagnostic imaging , Lung/physiopathology , Pulmonary Disease, Chronic Obstructive/pathology , Pulmonary Disease, Chronic Obstructive/physiopathology , Pulmonary Disease, Chronic Obstructive/therapyABSTRACT
Mepolizumab can reduce exacerbation rates in those with frequently exacerbating, severe COPD and raised blood eosinophils; this represents a further advance in precision medicine for COPD and targeted therapies http://ow.ly/uklu30m4YcU.