Expert review of respiratory medicine
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Although cannabis (or marijuana) is the world's most widely-used illicit drug, there has been surprisingly little research into its effects on respiratory health. Part of the problem is the inherent difficulty of studying the long-term effects of an illegal habit. It has often been assumed that smoking cannabis will have similar long-term effects to smoking tobacco. ⋯ However, there are numerous case reports of bullous emphysema among cannabis smokers. These findings have not been confirmed in systematic analytical studies and probably represent uncommon adverse effects in very heavy cannabis smokers. There is now additional controversial evidence that cannabis is at least an occasional cause of respiratory malignancies, but again the evidence is inconclusive.
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Expert Rev Respir Med · Aug 2011
ReviewGuidelines for aerosol devices in infants, children and adults: which to choose, why and how to achieve effective aerosol therapy.
Multiple types of aerosol devices are commonly used for the administration of medical aerosol therapy to patients with pulmonary diseases. All of these devices have been shown to be effective in trials where they are used correctly. ⋯ This article presents the rationale for selecting the most appropriate aerosol device to administer inhaled drugs in specific patient populations, with emphasis on patient-, drug-, device- and environment-related factors and with a comparison between the available devices. The following recommendations for the selection of the 'best' aerosol device for each patient population are intended to help clinicians gain a clear understanding of the specific issues and challenges so that they can optimize aerosol drug delivery and its therapeutic outcomes in patients.
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Tracheal replacement has been attempted since the beginning of the last century, but always failed because of the difficulties in harvesting and revascularizing its microvascular network and the necessity for heavy immunosuppression. Regenerative medicine is an emerging interdisciplinary field of research and clinical applications focused on the repair, replacement or regeneration of cells, tissues or organs to restore impaired function. ⋯ By doing so, immunosuppression is avoided. In this article, we describe the strategies that could have relevant clinical applications and the translational research approaches used to clinically replace irreversible diseases of the trachea, and discuss how to make this stem cell-based technology available to everyone.
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Expert Rev Respir Med · Aug 2011
Review Randomized Controlled Trial Multicenter StudyPirfenidone in idiopathic pulmonary fibrosis: the CAPACITY program.
Idiopathic pulmonary fibrosis is the most lethal form of diffuse lung fibrosis, killing approximately half of those affected within 2-3 years of diagnosis. Until recently, no therapies had been shown to have an impact on disease progression. The Clinical Studies Assessing Pirfenidone (Esbriet(®)) in IPF: Research of Efficacy and Safety Outcomes (CAPACITY) program comprised two almost identical double-blind placebo-controlled studies assessing the effects of pirfenidone on change in forced vital capacity, the primary end point, over a 72-week period. ⋯ The other study did not meet its primary end point but positive trends were consistent in this and a number of secondary end point indices. Safety was acceptable, comprising mainly problems of tolerability rather than toxicity. It is likely that pirfenidone will be utilised in many countries as first-line therapy and will also be included in studies of combination therapy for this attritional disease.