Current opinion in pulmonary medicine
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In patients with chronic obstructive pulmonary disease, nasal inflammation often coexists with lower respiratory disease. We review the current understanding of the relationship between upper and lower airway disease, particularly in chronic obstructive pulmonary disease, including therapeutic implications. ⋯ Patients with chronic obstructive pulmonary disease should be assessed for coexistent rhinosinusitis. Therapy directed toward treating the upper airway is likely to improve the global health status of these patients. Since tobacco smoke can exacerbate upper airway symptoms, it is important to evaluate patients with rhinosinusitis for concomitant lower airway disease.
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There is increasing interest in using multichannel computed-tomography scanning in the characterization of subjects with chronic obstructive pulmonary disease. Three distinct components - emphysema, large-airway inflammation and small-airway abnormality - have been evaluated using qualitative and quantitative approaches. Here we highlight computed-tomography findings of chronic obstructive pulmonary disease and correlation with spirometric values. ⋯ Volumetric computed-tomography scans allow diagnosis and quantification of the individual small airway and emphysema phenotypes present in people with chronic obstructive pulmonary disease. New computed-tomography scanning techniques should provide new insights into further understanding of the heterogeneity of chronic obstructive pulmonary disease.
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This review examines the role of long-acting beta2-adrenergic agonists in the management of asthma, particularly focusing on recommendations in the newly revised Global Initiative for Asthma (GINA) and National Heart, Lung, and Blood Institute (NHLBI) asthma guidelines. ⋯ In the recently updated GINA and NHLBI asthma guidelines, long-acting beta2-adrenergic agonists are an important class of agents for the management of persistent asthma in patients whose asthma is not well controlled with inhaled corticosteroid monotherapy.
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This article focuses on two novel asthma therapies - antibiotics and a procedure, bronchial thermoplasty. The challenges of identifying which treatment would best help an individual patient can be addressed by use of noninvasive measurements to define their asthma. ⋯ Asthma treatment is evolving beyond the current cornerstones of bronchodilation, leukotriene antagonism and corticosteroids. This change will be propelled by a more detailed description of individual patients' disease that will enable customization of treatment, and the development of specific interventions that modify disease mechanisms, including airway remodelling.
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Food allergy associated clinical and social burdens have increased substantially in prevalence in the past decade. Coexisting asthma is a significant problem as food reactions tend to be more severe when they involve the lung. Food allergy also increases asthma morbidity in adults and children. ⋯ Food allergies can be classified as IgE-mediated or non-IgE-mediated. Besides foods, some additives and preservatives can also trigger asthma in certain people. Asthma may develop in about 5% of individuals who suffer from food allergy and current asthma may be triggered by foods among 6-8% of children and 2% of adults. Because of the difficulty of confirming diagnosis of food allergy, novel approaches are currently being investigated and new therapy modalities are being sought. For total asthma control and for better quality of life, steps should be taken to avoid foods in cases of food allergy.