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1.
Expert Rev Respir Med ; 18(3-4): 99-110, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38690646

RESUMO

INTRODUCTION: Non-small cell lung cancer (NSCLC) is a disease commonly diagnosed in the elderly, often in advanced stages. However, elderly patients with lung cancer can benefit from surgery, provided that postoperative risks are assessed appropriately before surgery. Frailty is a measure of age-related impaired functional status and a predictor of mortality and morbidity. However, its importance as a preoperative marker is not well defined. AREAS COVERED: This systematic review discusses the importance of preoperative frailty screening in elderly patients with NSCLC. A literature search was performed on the MEDLINE database in June 2023, and relevant studies on frailty or preoperative assessment of NSCLC which were published between 2000 and 2023 were retained and discussed in this review. EXPERT OPINION: Among the types of existing methods used to assess frailty those on the geriatric assessment seem to be the most appropriate; however, they are unable to fully capture the 'surgical' frailty; thus, other instruments should be developed and validated in NSCLC.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Idoso Fragilizado , Fragilidade , Avaliação Geriátrica , Neoplasias Pulmonares , Humanos , Neoplasias Pulmonares/cirurgia , Neoplasias Pulmonares/diagnóstico , Fragilidade/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Idoso , Resultado do Tratamento , Cuidados Pré-Operatórios , Medição de Risco , Idoso de 80 Anos ou mais , Fatores de Risco , Fatores Etários
2.
Expert Opin Investig Drugs ; 32(4): 283-290, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-37017626

RESUMO

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a prevalent disease of the airways in which inhaled bronchodilators can be given as monotherapy or fixed dose combination, in order to better control disease symptoms and to reduce its morbidity. A novel bronchodilator approach is represented by bifunctional molecules such as navafenterol, which exert dual synergic bronchodilator effects as a monotherapy. Navafenterol is currently being investigated for COPD. AREAS COVERED: This review summarizes the preclinical data regarding navafenterol synthesis and in vitro and in vivo testing. Clinical data coming from phase I and II studies are also discussed. Navafenterol was found to improve lung function, dyspnea, and cough severity and was well tolerated, and its effect was comparable with that of fixed-dose combinations in patients with moderate-to-severe COPD. EXPERT OPINION: Despite clinical evidence of efficacy for navafenterol is still limited, the existing data prompts further clinical evaluation and also consideration of other inhalation approaches such as pressure metered-dose inhalers (pMDIs) or nebulization. Other interesting approach would be combination with another bifunctional molecule such as ensifentrine.


Assuntos
Broncodilatadores , Doença Pulmonar Obstrutiva Crônica , Humanos , Broncodilatadores/efeitos adversos , Antagonistas Muscarínicos/efeitos adversos , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Administração por Inalação , Combinação de Medicamentos , Agonistas de Receptores Adrenérgicos beta 2/efeitos adversos , Resultado do Tratamento
3.
Healthcare (Basel) ; 10(10)2022 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-36292275

RESUMO

The World Health Organization warns about the threat of the COVID-19 sixth wave. Our aim was to propose the first validated Romanian questionnaire to assess people's level of education and attitudes towards general measures to protect against COVID-19 infection. Our study was conducted on a sample of 194 people. The first version of the questionnaire consisted of 40 items. Items that did not meet psychometric criteria were removed. Latent components/factors were identified through exploratory factorial analysis (EFA). The Cronbach's alpha coefficient was used to assess internal fidelity. The EFA identified three factors. Factor 1 was named "Compliance with protective measures", factor 2 was "Attitudes toward vaccination" and factor 3 was "Attitudes regarding potential COVID-19 therapies". The final version of the questionnaire consists of 16 items. The test's final score predicted the presence of vaccination with an accuracy of 0.773. The questionnaire score, the diagnosis of diabetes, the advice provided by healthcare workers and the medical profession proved to be significant predictors of vaccination. The implementation of our questionnaire within national programs could identify populational areas that need specific interventions to reach vaccination targets and prevent a full-blown sixth wave of the COVID-19 pandemic in Romania.

4.
Vaccines (Basel) ; 10(5)2022 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-35632428

RESUMO

Herd immunity is necessary to control the coronavirus disease 2019 (COVID-19) pandemic. However, a low proportion of vaccinated people and low levels of vaccine acceptance have been noted in Eastern Europe. Our paper aimed to review the central attitudes associated with the hesitancy toward COVID-19 vaccination specific to Eastern European countries. The main Eastern European determinants of COVID-19 vaccine acceptance identified from the included studies are: public confidence in the vaccines' safety and efficacy, vaccine literacy, and public trust in the government and the medical system. Each of these determinants is discussed along with possible improvement measures. Variables specific to Eastern Europe that predict the willingness to vaccinate have also been highlighted. The specific attitudes and their context as identified by our review should be incorporated into local public health programs, with the ultimate goal of reducing viral spreading, mutation emergence, and COVID-19 morbidity and mortality both within the borders of Eastern Europe and beyond.

5.
Medicina (Kaunas) ; 58(1)2022 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-35056415

RESUMO

Introduction: Non-Hodgkin lymphomas (NHL) comprise 85% of the total lymphomas diagnosed, with the histological type of diffuse large B-cell lymphomas (DLBCL) being the most prevalent in adults. In about 40% of cases, the location is extranodal. Uterine cervix lymphomas of this type are extremely rare (0.5-1.5%) and represent a diagnostic challenge. A case of DLBCL of the cervix is presented here along with a review of the literature. Materials and methods: A 75-year-old patient was referred with a bleeding vegetant tumour occupying her entire vagina. The histological and pathological investigations performed following the tumour biopsy indicated a malignant, diffuse, vaguely nodular lymphoid tumour proliferation. The immunohistochemistry results were in favour of a diffuse B-cell non-Hodgkin lymphoma (DLBCL). CHOP (Cyclophosphamide, Hydroxydaunorubicin (also called doxorubicin or adriamycin), Oncovin (vincristine), Prednisone or Prednisolone) polychemotherapy and radiotherapy were effective and resulted in tumour regression (from 3.4 cm to tumour disappearance, with the cervix returning to normal size). Conclusions: The uterine cervix lymphoma prognosis is more conservative than that for a nodal lymphoma, mainly due to a later diagnosis determined via immunohistochemistry. Chemotherapy is the main treatment.


Assuntos
Linfoma Difuso de Grandes Células B , Linfoma não Hodgkin , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Colo do Útero , Feminino , Humanos , Linfoma Difuso de Grandes Células B/diagnóstico , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Linfoma não Hodgkin/diagnóstico , Linfoma não Hodgkin/tratamento farmacológico , Vincristina/uso terapêutico
6.
Expert Rev Respir Med ; 16(3): 257-261, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34793285

RESUMO

INTRODUCTION: SARS-COV2 infection represents a therapeutic challenge due to the limited number of effective therapies available and due to the fact that it is not clear which host response in terms of inflammation pattern is the most predictive for an optimal (and rapid) recovery. Interferon ß pathway is impaired in SARS-COV2 infection and this is associated with a bigger disease burden. Exogenous inhaled interferon might be beneficial in this setting. AREAS COVERED: Nebulized interferon-ß is currently investigated as a potential therapy for SARS-COV2 because the available data from a phase II study demonstrate that this medication is able to accelerate the recovery from disease. EXPERT OPINION: Further clinical studies are needed in order to better document the efficacy of this therapy especially in severe forms of COVID-19, the optimal duration of therapy and if such a medication is appropriate for domiciliary use. Also combined regimens with antivirals or with compounds which are able to enhance the endogenous production of interferon might be of promise.


Assuntos
Tratamento Farmacológico da COVID-19 , Interferons , Administração por Inalação , Antivirais/administração & dosagem , Ensaios Clínicos Fase II como Assunto , Humanos , Interferons/administração & dosagem , RNA Viral , SARS-CoV-2
7.
Drugs Today (Barc) ; 58(12): 605-620, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36651068

RESUMO

The SARS-COV-2 pandemic has been a global public health problem since 2019, with over 400 million reported cases, 6 million deaths, and significant economic and social damage. Overlapping SARS-CoV-2 infection in patients with chronic diseases, such as multiple sclerosis (MS), causes management problems, especially in patients treated with disease-modifying therapies. Studies investigating COVID-19 vaccination effectiveness have shown variability in postvaccination immune response that depends on the patient's background treatment, and special attention is required for anti-CD20 therapies. Existing data on the efficacy of COVID-19 vaccination in patients with MS undergoing disease-modifying treatment are summarized and critically evaluated in this article.


Assuntos
COVID-19 , Esclerose Múltipla , Humanos , Vacinas contra COVID-19 , Esclerose Múltipla/tratamento farmacológico , COVID-19/prevenção & controle , SARS-CoV-2 , Vacinação
8.
Mar Drugs ; 19(11)2021 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-34822457

RESUMO

One of the challenges to the management of severe asthma is the poor therapeutic response to treatment with glucocorticosteroids. Compounds derived from marine sources have received increasing interest in recent years due to their prominent biologically active properties for biomedical applications, as well as their sustainability and safety for drug development. Based on the pathobiological features associated with glucocorticoid resistance in severe asthma, many studies have already described many glucocorticoid resistance mechanisms as potential therapeutic targets. On the other hand, in the last decade, many studies described the potentially anti-inflammatory effects of marine-derived biologically active compounds. Analyzing the underlying anti-inflammatory mechanisms of action for these marine-derived biologically active compounds, we observed some of the targeted pathogenic molecular mechanisms similar to those described in glucocorticoid (GC) resistant asthma. This article gathers the marine-derived compounds targeting pathogenic molecular mechanism involved in GC resistant asthma and provides a basis for the development of effective marine-derived drugs.


Assuntos
Anti-Inflamatórios/uso terapêutico , Asma/tratamento farmacológico , Produtos Biológicos/uso terapêutico , Animais , Organismos Aquáticos , Resistência a Medicamentos , Glucocorticoides , Humanos , Índice de Gravidade de Doença
9.
Medicina (Kaunas) ; 57(9)2021 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-34577834

RESUMO

Occupational chronic obstructive pulmonary disease (oCOPD) represents 15-20% of the global burden of this disease. Even if industrial bronchitis has long been known, new occupational hazards continue to emerge and enlarge the number of people exposed to risk. This review discusses the challenges related to the early detection of oCOPD, in the context of new exposures and of limited usage of methods for an efficient disease occupational screening. It underlines that a better translation into clinical practice of the new methods for lung function impairment measurements, imaging techniques, or the use of serum or exhaled breath inflammation biomarkers could add significant value in the early detection of oCOPD. Such an approach would increase the chance to stop exposure at an earlier moment and to prevent or at least slow down the further deterioration of the lung function as a result of exposure to occupational (inhaled) hazards.


Assuntos
Doenças Profissionais , Doença Pulmonar Obstrutiva Crônica , Humanos , Doenças Profissionais/diagnóstico , Doenças Profissionais/epidemiologia , Doenças Profissionais/etiologia , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/etiologia , Fatores de Risco
10.
Medicina (Kaunas) ; 57(5)2021 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-34064756

RESUMO

Background and Objectives: In advanced chronic obstructive pulmonary disease (COPD), functional status is significantly impaired mainly as a result of disease related respiratory symptoms such as dyspnea or as a result of fatigue, which is the extra-respiratory symptom the most prevalent in this setting. "Physical" frailty, considered to be an aging phenotype, has defining traits that can also be considered when studying impaired functional status, but little is known about this relationship in advanced COPD. This review discusses the relevance of this type of frailty in advanced COPD and evaluates it utility and its clinical applicability as a potential outcome measure in palliative care for COPD. Materials and Methods: A conceptual review on the functional status as an outcome measure of mortality and morbidity in COPD, and an update on the definition and traits of frailty. Results: Data on the prognostic role of frailty in COPD are rather limited, but individual data on traits of frailty demonstrating their relationship with mortality and morbidity in advanced COPD are available and supportive. Conclusions: Frailty assessment in COPD patients is becoming a relevant issue not only for its potential prognostic value for increased morbidity or for mortality, but also for its potential role as a measure of functional status in palliative care for advanced COPD.


Assuntos
Fragilidade , Doença Pulmonar Obstrutiva Crônica , Dispneia/etiologia , Estado Funcional , Humanos , Prognóstico
11.
Expert Opin Pharmacother ; 22(7): 835-847, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33372557

RESUMO

Introduction: Chronic obstructive pulmonary disease (COPD) is progressive inflammatory disease of the lungs in which smoking plays a significant pathogenic role. Smoking cessation is the only therapeutic intervention which was demonstrated to interfere with disease progression. Smoking cessation intervention can benefit from pharmacological therapies such as nicotine replacement therapies, bupropion, or varenicline which can be given individually or in combination, their effectiveness being demonstrated in various clinical trials enrolling COPD patients.Areas covered: The authors provide a pragmatic discussion of the clinical data of the main studies evaluating therapies for smoking cessation within COPD starting with the seminal Lung Health Study and continuing with more recent ones.Expert opinion: Smoking cessation is one of the most difficult therapeutic interventions in COPD, despite having the highest impact on disease progression and despite the demonstrated benefit of the discussed pharmacological therapies. Potential approaches to maximize its chance of success might be represented by prolonging the time of administration, combinational options, or sequential pharmacotherapy.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Abandono do Hábito de Fumar , Benzazepinas , Bupropiona/uso terapêutico , Humanos , Nicotina , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Quinoxalinas , Dispositivos para o Abandono do Uso de Tabaco , Vareniclina/uso terapêutico
12.
Medicina (Kaunas) ; 56(9)2020 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-32825456

RESUMO

Background and objectives: Data about pulmonologist adherence to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines showed a great variability and cannot be extrapolated. The present study investigates the current pharmacological prescribing practices in the treatment of chronic obstructive pulmonary disease (COPD) according to the 2017 GOLD guidelines, to determine the level of pulmonologist adherence and to identify possible factors that influence physician adherence. Materials and methods: This retrospective study took place between 1 February and 30 April 2018 in Pneumophtysiology Clinical Hospital Cluj-Napoca. We included 348 stable COPD outpatients classified according to the 2017 GOLD strategy in the ABCD risk groups. Pulmonologist adherence was defined as appropriate if the recommended pharmacological therapy was the first- or alternative-choice drug according to the guidelines, and inappropriate (overtreatment, undertreatment) if it was not in line with these recommendations. Results: The most prescribed treatment was the combination long-acting beta agonist (LABA) + long-acting antimuscarinic agent (LAMA) (34.77%), followed by LAMA + LABA + inhaled corticosteroid (ICS). Overall, pneumologist adherence was 79.02%. The most inappropriate therapies were in Group B (33.57%), followed by 33.33% in Group A. Compared to Groups C and D (analyzed together), Groups A and B had a 4.65 times higher chance (p = 0.0000001) of receiving an inappropriate therapy. Patients with cardiovascular comorbidities had a 1.89 times higher risk of receiving an inappropriate therapy (p = 0.021). ICS overprescription was the most common type of inappropriateness (17.81%). Groups C and D had a 3.12 times higher chance of being prescribed ICS compared to Groups A and B (p = 0.0000004). Conclusions: Pulmonologist adherence to the GOLD guidelines is not optimal and needs to be improved. Among the factors that influence the inappropriateness of COPD treatments, cardiovascular comorbidities and low-risk Groups A and B are important. ICS represent the most prescribed overtreatment. Further multicentric studies are needed to evaluate all factors that might influence the adherence rate.


Assuntos
Fidelidade a Diretrizes , Guias de Prática Clínica como Assunto , Padrões de Prática Médica , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Corticosteroides/uso terapêutico , Agonistas Adrenérgicos beta/uso terapêutico , Idoso , Feminino , Objetivos , Humanos , Masculino , Uso Excessivo dos Serviços de Saúde , Antagonistas Muscarínicos/uso terapêutico , Pneumologistas , Estudos Retrospectivos , Fatores de Risco
13.
Expert Opin Pharmacother ; 21(11): 1359-1366, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32511020

RESUMO

INTRODUCTION: Pulmonary alveolar proteinosis (PAP) is a heterogeneous group of rare diseases characterized by the abnormal production and impaired degradation of pulmonary surfactant as a result of malfunctioning of alveolar macrophages. This is due to the downstream dysregulation of the GM-CSF pathway, which can be caused by specific autoantibodies (autoimmune, aPAP formerly known as idiopathic iPAP), direct injury to alveolar macrophages (e.g. by toxic inhaled agents.), or by genetic defects (hereditary or congenital PAP). Few pharmacotherapy options are currently available to treat this disease. AREA COVERED: The authors discuss the exogenous administration of GM-CSF, rituximab, and the potential role of cholesterol lowering medications in this review. The authors, furthermore, provide their opinion on the available pharmacotherapeutic options and give their future perspectives. EXPERT OPINION: Inhaled GM-CSF remains the most commonly used therapy in patients with iPAP but other inhaled therapies such as PPARγ activators should be considered, especially in patients who are partially responsive or unresponsive to traditional treatments.


Assuntos
Fator Estimulador de Colônias de Granulócitos e Macrófagos/uso terapêutico , Proteinose Alveolar Pulmonar/tratamento farmacológico , Rituximab/uso terapêutico , Administração por Inalação , Animais , Autoanticorpos/imunologia , Ensaios Clínicos como Assunto , Terapia Genética , Fator Estimulador de Colônias de Granulócitos e Macrófagos/administração & dosagem , Fator Estimulador de Colônias de Granulócitos e Macrófagos/efeitos adversos , Humanos , Injeções Subcutâneas , Metabolismo dos Lipídeos/efeitos dos fármacos , Macrófagos Alveolares/efeitos dos fármacos , Macrófagos Alveolares/imunologia , Macrófagos Alveolares/metabolismo , Proteinose Alveolar Pulmonar/genética , Proteinose Alveolar Pulmonar/imunologia , Proteinose Alveolar Pulmonar/metabolismo , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/efeitos adversos , Proteínas Recombinantes/uso terapêutico , Rituximab/administração & dosagem , Rituximab/efeitos adversos
14.
Expert Opin Pharmacother ; 21(9): 997-1004, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32237914

RESUMO

INTRODUCTION: In chronic obstructive pulmonary disease (COPD), inhaled long-acting antimuscarinic agents (LAMA) are effective maintenance therapies used across all severity stages of the disease. Most of them are administered via dry powder inhalers, but these devices require a potent inspiratory flow which cannot be effectively achieved by patients with advanced disease. In such patients, inhaled therapy via nebulization might be an option. AREAS COVERED: Revefenacin is a LAMA that was specifically formulated for once daily nebulization and which was authorized by the FDA as a maintenance therapy for COPD. In phase II and III clinical studies discussed in this review, revefenacin demonstrated its rapid onset of action and sustained effect on lung function on both a short- and long-term basis. EXPERT OPINION: Nebulized revefenacin with once daily use does not require any particular effort of administration and hence can be used by patients with severe airways obstruction or by those having milder cognitive deficits. Further studies are needed, however, to better document the long-term cardiovascular safety and its ability to reduce the exacerbation rate.


Assuntos
Benzamidas/uso terapêutico , Carbamatos/uso terapêutico , Antagonistas Muscarínicos/uso terapêutico , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Benzamidas/farmacocinética , Benzamidas/farmacologia , Carbamatos/farmacocinética , Carbamatos/farmacologia , Humanos , Antagonistas Muscarínicos/farmacocinética , Antagonistas Muscarínicos/farmacologia
15.
Clin Respir J ; 13(12): 735-740, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31437358

RESUMO

INTRODUCTION: In COPD management, the improvement of the health status by alleviating respiratory symptoms is among the main aims. However, little is known on the prevalence and burden of extra-respiratory symptoms which can also be distressing especially during a COPD exacerbation. OBJECTIVES: To evaluate the prevalence of extra-respiratory symptoms and their impact on health and functional statuses in patients hospitalized for a COPD exacerbation. METHODS: Health status was evaluated with the COPD Assessment Test (CAT), functional status with Karnofsky index, and presence and severity of respiratory symptoms were evaluated with Edmonton Symptom Assessment Scale (ESAS). RESULTS: In a sample of 47 patients, fatigue was found to be the most prevalent 95.7% followed by pain 74.5%, lack of appetite 72.3%, depression and anxiety (each in 63.8%), drowsiness 59.6% and nausea 31.9%. The concomitant presence of an increasing number of symptoms (three, four, five, six or seven) was individually associated with worse health status or of functional status (eg, CAT score in patients with three most prevalent symptoms, fatigue, pain and lack of appetite 29.6 vs 25.1, P = .006 in patients without them; Karnofsky index scores in patients with the four most prevalent symptoms 52 vs 65.6, P = .001). Linear regressions confirmed that the increase in the number of concomitant extra-respiratory symptoms significantly correlated with the worsening of health/functional status. In conclusion, the burden of extra-respiratory symptoms in patients with hospitalized for a COPD exacerbation is significant and impact significantly on health/functional status.


Assuntos
Avaliação de Estado de Karnofsky/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Avaliação de Sintomas/métodos , Idoso , Ansiedade/epidemiologia , Apetite/fisiologia , Efeitos Psicossociais da Doença , Depressão/epidemiologia , Progressão da Doença , Fadiga/epidemiologia , Feminino , Nível de Saúde , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Dor/epidemiologia , Prevalência , Doença Pulmonar Obstrutiva Crônica/fisiopatologia
16.
Expert Opin Investig Drugs ; 27(2): 139-146, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29338445

RESUMO

INTRODUCTION: Bronchiectasis not related to cystic fibrosis (non-CF bronchiectasis) are associated with a high unmet therapeutic need due to the lack of specifically authorized medications, especially via the inhalation route. In non-CF bronchiectasis chronic infection with Pseudomonas aeruginosa is common and favored by the persistent local inflammation and viscid sputum production. Therefore inhaled antibiotics, mucolytics or anti-inflammatory agents could represent appropriate therapeutic interventions in this setting. AREAS COVERED: This review herein discusses the inhaled therapies currently under investigation for non-CF bronchiectasis and their potential therapeutic positioning in exacerbation versus stable state. EXPERT OPINION: Inhaled antipseudomonal antibiotics are of promising efficacy, but further efforts should also be made to detect bactericidal approaches against Burkholderia cepacia complex, and to interfere chronic inflammation topically.


Assuntos
Bronquiectasia/tratamento farmacológico , Desenho de Fármacos , Drogas em Investigação/uso terapêutico , Administração por Inalação , Animais , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/uso terapêutico , Bronquiectasia/etiologia , Bronquiectasia/microbiologia , Doença Crônica , Drogas em Investigação/administração & dosagem , Drogas em Investigação/farmacologia , Expectorantes/administração & dosagem , Expectorantes/uso terapêutico , Humanos , Infecções por Pseudomonas/tratamento farmacológico , Pseudomonas aeruginosa
17.
Expert Opin Biol Ther ; 17(7): 895-900, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28406319

RESUMO

INTRODUCTION: Current anti-inflammatory asthma therapies including inhaled corticosteroids and leukotriene modifiers, are not always able to appropriately control the disease and other approaches are needed. These therapies specific target IgE (omalizumab) or IL-5 (mepolizumab). However, there is research underway investigating interleukin-based monoclonal antibodies such as benralizumab, an anti-IL-5R monoclonal antibody which is currently in phase III clinical development. Areas covered: This review summarizes the existing preclinical and clinical data of benralizumab. Data reviewed includes benralizumab's efficacy and safety data. The author also provides their expert opinion on this potential therapeutic and provide their perspectives for its future development. Expert opinion: Benralizumab was able to interfere significantly with disease-related morbidity and in particular with hospitalizations due to asthma exacerbation rates in a subset of patients with higher systemic eosinophil burden and higher doses of inhaled corticosteroids. The sustained inhibitory effect on eosinophilic inflammation might be an advantage which can be translated in less frequent dosing. Further attempts should be made to better define the asthma endotype in which such an antibody would be the most efficacious.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Asma/tratamento farmacológico , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais/imunologia , Anticorpos Monoclonais Humanizados/efeitos adversos , Anticorpos Monoclonais Humanizados/imunologia , Asma/patologia , Ensaios Clínicos como Assunto , Eosinófilos/imunologia , Humanos , Vigilância de Produtos Comercializados , Receptores de Interleucina-5/imunologia
18.
Expert Opin Investig Drugs ; 25(10): 1239-49, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27554950

RESUMO

INTRODUCTION: In asthma, most commonly, 'conventional' anti-inflammatory medications represented by inhaled corticosteroids and leukotriene inhibitors are effective. In some patients however additional inhibition of the airways inflammation is necessary. Such compounds might be molecules inhibiting specifically certain inflammation pathways and lebrikizumab an anti IL-13 molecule might represent a relevant example as a potential asthma therapy. AREAS COVERED: Discussion of the rationale for the use of lebrikizumab in asthma. Analysis of the related preclinical and clinical data on lebrikizumab in asthma. EXPERT OPINION: Lebrikizumab demonstrated efficacy in an asthma subset characterized by high serum periostin levels and by heavy eosinophilic inflammation. Phase III data are necessary in order to better position this therapy in asthma including as a potential personalized approach.


Assuntos
Antiasmáticos/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Asma/tratamento farmacológico , Antiasmáticos/farmacologia , Anticorpos Monoclonais/farmacologia , Asma/fisiopatologia , Desenho de Fármacos , Humanos , Interleucina-13/antagonistas & inibidores , Interleucina-13/imunologia
19.
Artigo em Inglês | MEDLINE | ID: mdl-26967768

RESUMO

In chronic obstructive pulmonary disease (COPD), palliative care is appropriate in very advanced stages based on recognition of its need when conventional therapy is no longer able to control symptoms, disease morbidity, or to improve/maintain an acceptable quality of life. Palliative care aims to improve quality of life, or, if applied specifically at the end-of-life, to ensure comfortable care. In COPD palliative care effectiveness of interventions should be quantified with outcome measures able to better capture the holistic nature of approaches and not only the specific features of disease. These should include: physical outcomes, psychological outcomes, social outcomes, spiritual outcomes. Such measures are discussed in this review along with arguments supporting their use.


Assuntos
Avaliação de Resultados em Cuidados de Saúde/métodos , Cuidados Paliativos/métodos , Doença Pulmonar Obstrutiva Crônica/terapia , Humanos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Qualidade de Vida
20.
Ther Adv Respir Dis ; 10(1): 26-33, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26596633

RESUMO

INTRODUCTION: Fatigue, which is also present in the healthy population, is a common but understudied symptom in chronic obstructive pulmonary disease (COPD). We hypothesized that clinically significant fatigue is also frequent in COPD and can be associated with an increased disease burden. METHODS: An exploratory analysis derived from an ongoing cross-sectional study was carried out to evaluate levels of fatigue and impact on health-related quality of life/health status in patients with COPD (COPD group; n = 20) and healthy subjects (control group; n = 5). Health-related quality of life was measured using the Short Form Health Survey 36 (SF-36), health status with the Clinical COPD Questionnaire (CCQ), and airways obstruction with postbronchodilator forced expiratory volume in 1 s (FEV1 %predicted). Fatigue was measured with the vitality score of the SF-36, its clinical significance being defined by values of 50 or less. Fatigue was also measured using the Functional Assessment of Chronic Illness Therapy scale for fatigue (FACIT-F). RESULTS: Vitality scores were significantly worse in the COPD group (45.60 versus 76.25; p = 0.004). FACIT-F scores were significantly lower in the COPD group versus the control group (74.5 versus 95.0; p = 0.03). Clinically significant fatigue was detected in 60% of the COPD group, and was associated with a worse FEV1 %predicted (47.71 versus 65.82%; p = 0.016), worse symptoms burden (CCQ symptoms score 3.75 versus 2.43; p = 0.019), and worse overall health status (CCQ total score 3.30 versus 2.11; p = 0.011). Its link with systemic inflammation remains to be clarified further. CONCLUSIONS: Clinically significant fatigue is common among patients with COPD and is associated with an increased disease burden. It should therefore be integrated as a measure of disease prognosis and control in patients with COPD.


Assuntos
Fadiga/epidemiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Qualidade de Vida , Idoso , Estudos de Casos e Controles , Estudos Transversais , Fadiga/etiologia , Feminino , Volume Expiratório Forçado , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Índice de Gravidade de Doença
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