American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Oct 2015
Randomized Controlled TrialA Randomized, Placebo-controlled Trial of Roflumilast on Proline-glycine-proline and Neutrophilic Inflammation in COPD.
Roflumilast is a therapeutic agent in the treatment of chronic obstructive pulmonary disease (COPD). It has antiinflammatory effects; however, it is not known whether it can affect a biologic pathway implicated in COPD pathogenesis and progression. The self-propagating acetyl-proline-glycine-proline (AcPGP) pathway is a novel means of neutrophilic inflammation that is pathologic in the development of COPD. AcPGP is produced by extracellular matrix collagen breakdown with prolyl endopeptidase and leukotriene A4 hydrolase serving as the enzymes responsible for its production and degradation, respectively. ⋯ Roflumilast reduces pulmonary inflammation through decreasing prolyl endopeptidase activity and AcPGP. As expected for lower AcPGP levels, markers of neutrophilic inflammation are blunted. Inhibiting this self-propagating pathway lessens the overall inflammatory burden, which may alter the natural history of COPD, including the risk of exacerbation. Clinical trial registered with www.clinicaltrials.gov (NCT 01572948).
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Am. J. Respir. Crit. Care Med. · Oct 2015
Multicenter StudyIncidence and Prognostic Value of the Systemic Inflammatory Response Syndrome and Organ Dysfunctions in Ward Patients.
Tools that screen inpatients for sepsis use the systemic inflammatory response syndrome (SIRS) criteria and organ dysfunctions, but most studies of these criteria were performed in intensive care unit or emergency room populations. ⋯ Almost half of patients hospitalized on the wards developed SIRS at least once during their ward stay. Our findings suggest that screening ward patients using SIRS criteria for identifying those with sepsis would be impractical.
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Am. J. Respir. Crit. Care Med. · Oct 2015
Effects of Recipient Age and Diagnosis on Health-Related Quality of Life Benefit of Lung Transplantation.
The average age of lung transplant recipients is increasing, and the mix of recipient indications for transplantation is changing. ⋯ Lung transplantation confers large HRQL benefits, which vary by recipient diagnosis, but do not differ substantially in older recipients.