Respiratory medicine
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Respiratory medicine · Nov 2006
ReviewManagement of asthma with anti-immunoglobulin E: a review of clinical trials of omalizumab.
Immunoglobulin E (IgE) is a key mediator of the inflammatory reactions that are central to the pathogenesis of allergic diseases such as asthma and rhinitis. The recognition of the importance of IgE in allergic disease led to the development of omalizumab, a humanized monoclonal anti-IgE antibody that binds free circulating IgE and prevents the interaction between IgE and high-affinity (FcepsilonRI) and low-affinity (FcepsilonRII) IgE receptors on inflammatory cells. By removing free IgE, omalizumab also markedly downregulates the expression of high-affinity receptors on basophils, mast cells and dendritic cells. ⋯ Patients with uncontrolled severe persistent allergic asthma are a challenging and difficult-to-treat population for whom omalizumab might represent an important new treatment option. In addition, omalizumab may provide a means to address comorbid allergic disease in patients with asthma. Further investigation is also warranted to explore potential applications of omalizumab in occupational asthma.
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Pulmonary embolism (PE) is the commonest cause of maternal death in UK. It is a frequently occurring diagnostic challenge. The false negative and false positive rates for the diagnosis of PE are spectacularly high. ⋯ Physiologic changes of pregnancy further complicate the diagnosis of PE. Although the danger of maternal and foetal death secondary to maternal PE and unnecessary anticoagulation far outweighs the risk of radiation involved in scanning, doctors still hesitate to request appropriate investigation because of concern regarding radiation exposure to the foetus and the absence of any clear, updated guideline. Worried parents need to be counselled appropriately before tests to alleviate anxiety and misunderstanding.
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Respiratory medicine · Jul 2006
Review Meta AnalysisShort-burst oxygen therapy in chronic obstructive pulmonary disease.
Despite widespread prescription, the efficacy of short-burst oxygen therapy has not been established. ⋯ The studies in this review suggest that the widespread prescription of short-burst oxygen is not evidence-based. If prescription is to continue, the scientific rationale for short-burst oxygen therapy must be established.
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Pulmonary arterial hypertension (PAH) is a devastating disease that leads to right heart failure and premature death. Historically, we are restricted by limited options for drug treatment. Over the past decade, with advances in our understanding of pathophysiological and molecular mechanisms, many new therapeutic strategies (synthetic prostacyclin and prostacyclin analogues, endothelin receptor antagonists and sildenafil) have been developed for the treatment of PAH, and the clinical efficacy has been tested in many randomized-controlled trials (RCTs). In this overview, we review the evidence for the use of historical and new treatments that arises from the Cochrane Collaboration of Systematic Reviews and from recent RCTs.
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Respiratory medicine · Feb 2006
ReviewEvidence for physical therapies (airway clearance and physical training) in cystic fibrosis: an overview of five Cochrane systematic reviews.
A range of physical therapies (including airway clearance and physical training) are used in cystic fibrosis (CF). The aim of this paper is to summarise the main findings from Cochrane systematic reviews that have considered the evidence for physical therapies in CF. ⋯ The Cochrane systematic reviews summarised in this paper provide some evidence to support the inclusion of physical therapies in the care-management plan of CF. They also provide information to steer the direction and focus of future research in this area.