Expert review of respiratory medicine
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Expert Rev Respir Med · May 2020
ReviewExtracorporeal membrane oxygenation support in adult patients with acute respiratory distress syndrome.
Introduction: The global number of patients receiving extracorporeal membrane oxygenation (ECMO) support has been growing after several studies highlighted the favorable results attained in cases of severe respiratory failure. However, evidence-based guidelines for optimal use of ECMO are lacking. Areas covered: This review covers optimal candidates, timing of initiation, strategies for patient management including mechanical ventilation, and decision-making regarding discontinuation of ECMO based on its potential role in treatment of patients with acute respiratory distress syndrome. ⋯ Use of a comprehensive management approach for preventing additional lung injury and extrapulmonary organ failure is critical during ECMO support to ensure the best outcome. The possibility of weaning from ECMO should be fully assessed by a multidisciplinary team during ECMO support. Futility should not be determined solely by duration of ECMO, and use of prolonged ECMO for lung recovery may be worthwhile.
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Expert Rev Respir Med · Apr 2020
ReviewAntibodies targeting the interleukin-5 signaling pathway used as add-on therapy for patients with severe eosinophilic asthma: a review of the mechanism of action, efficacy, and safety of the subcutaneously administered agents, mepolizumab and benralizumab.
Introduction: Since the discovery of eosinophils in the sputum of asthmatic patients, several studies have offered evidence on their prominent role in the pathology and severity of asthma. Blood eosinophils, are a useful biomarker for therapy selection in severe asthma patients. IL-5 plays crucial role on maturation, activation, recruitment, and survival of eosinophils and constitutes an important therapeutic target for patients with severe uncontrolled eosinophilic asthma. ⋯ Expert opinion: Both mepolizumab and benralizumab are promising for the treatment of severe eosinophilic asthma resulting in asthma control improvement and exacerbations reduction and can serve as steroid-sparing agents. However, since no head-to-head comparisons exist, it is unknown whether their different mechanisms of action might be related to different efficacy in specific patients' sub-phenotypes. Long-term clinical observations will provide real-world evidence regarding their lasting effectiveness and safety.
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Expert Rev Respir Med · Apr 2020
ReviewAcute exacerbations of idiopathic pulmonary fibrosis (AE-IPF): an overview of current and future therapeutic strategies.
Introduction: Idiopathic pulmonary fibrosis (IPF), the most common of the idiopathic interstitial pneumonias, is a disease with a poor prognosis, and a highly heterogeneous and unpredictable clinical course. While most patients experience a relatively slow clinical, functional and radiological deterioration, a significant minority develops episodes of acute respiratory worsening termed acute exacerbations of IPF (AE-IPF). AE-IPF cannot be predicted or prevented and precede approximately half of IPF-related deaths. ⋯ Efforts should be made to identify patients at higher risk for AE-IPF and detect early signs of these events. Potential treatment options should be studied in randomized, controlled trials. To this end, the importance of international collaborations cannot be overemphasized.
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Expert Rev Respir Med · Mar 2020
ReviewA comprehensive review of the use and understanding of airway pressure release ventilation.
Introduction: Airway pressure release ventilation (APRV) is a mode of ventilation typically utilized as a rescue or alternative mode for patients with acute respiratory distress syndrome (ARDS) and hypoxemia that is refractory to conventional mechanical ventilation. APRV's indication and efficacy continue to remain unclear given lack of consensus amongst practitioners, inconsistent methodology for its use, and scarcity of convincing evidence. Areas covered: This review discusses the history of APRV, how APRV works, rationales for its use, and its theoretical advantages and disadvantages. ⋯ Appropriate study of APRV's clinical efficacy is difficult given a heterogeneous patient population and widely variable use of APRV between centers. Despite a paucity of definitive evidence in support of either mode, it is possible that the use of APRV will begin to outpace the use of high-frequency oscillatory ventilation (HFOV) for the management of refractory hypoxemia as more attention is paid to benefits of spontaneous breathing and minimizing sedation. Furthermore, APRV's role during ECMO deserves further investigation.
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Expert Rev Respir Med · Mar 2020
ReviewNovel noncoding RNAs biomarkers in acute respiratory distress syndrome.
Introduction: Acute respiratory distress syndrome (ARDS) is a very common condition associated with critically ill patients, which causes substantial morbidity and mortality. Currently, there is no effective clinical ARDS treatment strategy. Novel targets that effectively treat ARDS need to be found. ⋯ In some cases, lncRNA MALAT1 target TLR4 to mediate the p38 MAPK and NF-κB signaling pathway in ARDS rat model. In other cases, lncRNA CASC2 was found to act as a ceRNA of miR-144-3p which directly targeted AQP1 in LPS-induced A549 cell. In addition, other miRNA-lncRNA regulatory patterns in ARDS and novel biomarkers still require deeper research.