Respiratory medicine
-
Respiratory medicine · Jan 2010
ReviewA review of prostaglandin analogs in the management of patients with pulmonary arterial hypertension.
Pulmonary arterial hypertension is a chronic, progressive disease characterized by elevation of pulmonary artery pressure and pulmonary vascular resistance that ultimately results in right ventricular failure and death. Multiple mechanisms are involved in the pathogenesis of pulmonary arterial hypertension, including prostacyclin, endothelin-1, and nitric oxide pathways amongst others. The first agent to be approved for the treatment of pulmonary arterial hypertension was synthetic prostacyclin (epoprostenol), followed by prostaglandin analogs (iloprost, treprostinil, and beraprost [Japan and Korea]), which act on prostaglandin receptors. ⋯ Different prostaglandin analogs have disparate binding affinities for the various prostaglandin receptors and different G-protein-coupled receptor interactions, which may result in varying clinical efficacy and safety depending on the target tissue. Differences in formulation, route of administration, effectiveness, and safety may all play a role in deciding which prostaglandin analog to prescribe for an individual patient. Head-to-head studies will be needed to confirm differences in efficacy and safety for the various prostaglandin analogs.
-
Respiratory medicine · Dec 2009
ReviewRecent advances in the diagnosis and treatment of multidrug-resistant tuberculosis.
Tuberculosis (TB) is a major infectious disease killing nearly two million people, mostly in developing countries, every year. The increasing incidence of resistance of Mycobacterium tuberculosis strains to the most-effective (first-line) anti-TB drugs is a major factor contributing to the current TB epidemic. Drug-resistant strains have evolved mainly due to incomplete or improper treatment of TB patients. ⋯ Once identified, successful treatment of MDR-TB requires therapy with several effective drugs some of which are highly toxic, less efficacious and expensive. Minimum treatment duration of 18-24 months is also long, making it difficult for health care providers to ensure adherence to treatment. Successful treatment has been achieved by supervised therapy with appropriate drugs at institutions equipped with facilities for culture, drug susceptibility testing of MDR-TB strains to second-line drugs and regular monitoring of patients for adverse drug reactions and bacteriological and clinical improvement.
-
Recently, heater/humidifier devices that use novel methods to condition breathing gases from an external source have been introduced. The addition of sufficient warmth and high levels of humidification to breathing gas has allowed for higher flow rates from nasal cannula devices to be applied to patients (i.e., high flow therapy). This article provides a review of the proposed mechanisms behind the efficacy of high flow therapy via nasal cannula, which include washout of nasopharyngeal dead space, attenuation of the inspiratory resistance associated with the nasopharynx, improvement in conductance and pulmonary compliance, mild distending pressure and reduction in energy expenditure for gas conditioning.
-
Respiratory medicine · Oct 2009
Review Meta AnalysisTiotropium and risk for fatal and nonfatal cardiovascular events in patients with chronic obstructive pulmonary disease: systematic review with meta-analysis.
There are safety concerns regarding the use of anticholinergics in the COPD patient population. The purpose of this review was to evaluate the cardiovascular risk of regular use of inhaled tiotropium bromide in patients with COPD of any severity. ⋯ Compared with control (placebo or salmeterol), tiotropium did not significantly increase the risk of adverse major cardiovascular events among COPD patients. Subgroup analysis suggested that smoking history can modify the risk of cardiovascular adverse events.
-
The efficacy and technical aspects of endobronchial ultrasound (EBUS) are reviewed because this technology promises to revolutionise bronchoscopy. EBUS extends the endoscopist's view beyond the mucosal surface of the large airways to peri-bronchial structures and peripheral lung lesions. Guided biopsies and real-time transbronchial needle aspirations (TBNA) have been shown to increase the diagnostic yield over conventional bronchoscopic techniques. ⋯ Complications are rare with either EBUS modality and are usually related to the underlying biopsy procedure rather than the use of ultrasound. Procedure duration is short enough to be incorporated into an outpatient setting and can performed under moderate sedation. Clear training standards are emerging to facilitate credentialing as EBUS is rapidly evolving to become a part of standard diagnostic bronchoscopy.