American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Jul 2017
ReviewHow Do Dual Long-acting Bronchodilators Prevent Exacerbations of Chronic Obstructive Pulmonary Disease?
Decreasing the frequency and severity of exacerbations is one of the main goals of treatment for patients with chronic obstructive pulmonary disease. Several studies have documented that long-acting bronchodilators can reduce exacerbation rate and/or severity, and others have shown that combinations of long-acting β2-adrenergic agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) provide greater reductions in exacerbation frequency than either their monocomponents or LABA/inhaled corticosteroid combinations in patients at low and high risk for these events. In this review, small groups of experts critically evaluated mechanisms potentially responsible for the increased benefit of LABA/LAMA combinations over single long-acting bronchodilators or LABA/inhaled corticosteroids in decreasing exacerbation. ⋯ The data assembled and analyzed by each group were reviewed by all authors and combined into this manuscript. Available clinical results support the possibility that effects of LABA/LAMA combinations on hyperinflation, mucociliary clearance, and symptom severity may all contribute to decreasing exacerbations. Although preclinical studies suggest LABAs and LAMAs have antiinflammatory effects, such effects have not been demonstrated yet in patients with chronic obstructive pulmonary disease.
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Am. J. Respir. Crit. Care Med. · Jul 2017
ReviewFifty Years of Research in ARDS. Insight into ARDS - From Models to Patients.
Clinicians who treat patients with acute respiratory distress syndrome (ARDS) use information and guidance from a wide array of sources, ranging from laboratory experiments, clinical data, health services research, intuition, to personal experience. Each of these sources of information brings unique methodology and information, but each is inherently limited. ⋯ However, an overwhelming body of knowledge has accumulated in the field from multiple sources. In this review, we describe the nature of some of these sources as they relate to ARDS and review examples of when they have succeeded (and sometimes failed) in shaping practice or advancing knowledge about ARDS.