bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment effects of sleep apnoea: where are we now?
Authors: Buyse B. 
Published: September 2008

The present article summarises some of the topics of discussion held during one of the workshops in preparation for the 7thInternational Symposium of the Katholieke Universiteit Leuven on “Respiratory somnology: a clinical update; March 2006”. Participants discussed the effectiveness of treatment in obstructive sleep apnoea/hypopnoea syndrome (OSAHS).Of the topics discussed, the following are considered in the present article. 1) Sleepiness and attention deficit, as well as higher cognitive/executive defects in OSAHS, and the closely related clinical dilemma of “how to deal with the car-driving-ability problem in OSAHS”. 2) Continuous positive airway pressure (CPAP) in post-stroke patients. The most important data discussed during the workshop for 1) and 2) are presented in the present article. 3) The effects of CPAP on metabolic outcome. One metabolic dysfunction of OSAHS is the change in leptin and ghrelin levels, which represent the “yin and yang” of an appetite regulatoion system that has developed to inform the brain about the current energy balance state. Data on the impact of sleep loss, either behavioural or OSAHS-related, on this neuroendocrine regulation of appetite are also presented.The participants ended the workshop with a discussion session on the results of more “controversial” treatment strategies for obstructive sleep apnoea/hypopnoea syndrome, such as cardiac pacing, hyoid bone expansion (a preliminary surgical technique), drug treatment for obstructive sleep apnoea/hypopnoea syndrome, female hormone replacement therapy and the role of stimulants for refractory sleepiness in already treated obstructive sleep apnoea/hypopnoea syndrome patients.
Treatment of obstructive and central sleep apnoea in heart failure: practical options: Table 1—
Authors: Javaheri S. 
Published: September 2008

Sleep apnoea, both central and obstructive disordered breathing, commonly occurs in patients with heart failure.Obstructive sleep apnoea occurs both in systolic and diastolic heart failure and is best treated with nasal positive airway pressure devices.Central sleep apnoea occurs primarily in systolic heart failure and therapeutic options are evolving.Optimal therapy of systolic heart failure, nocturnal use of supplemental oxygen, theophylline, acetazolamide and positive airway pressure devices have been shown to improve central sleep apnoea. Among these therapeutic modalities only continuous positive airway pressure has been studied in a long-term trials; unfortunately, it failed to improve survival.
Metabolic disturbances in patients with obstructive sleep apnoea syndrome
Authors: Harsch I. A. 
Published: September 2008

The metabolic disturbances in patients with obstructive sleep apnoea syndrome (OSAS) include insulin resistance and elevated levels of pro-inflammatory cytokines and vascular adhesion molecules, as well as an elevation of hormones derived from the adipose tissue as leptin. These phenomena might, in part, be an explanation for the excess morbidity and mortality of OSAS patients concerning cardiovascular disease.Several of these factors have been described as being independently associated with OSAS and not only related to its comorbidities, including obesity.A promising approach to studying the metabolic phenomena in these OSAS patients would be to monitor patients before and during the course of continuous positive airway pressure therapy, as nocturnal sleep disturbances are treatable and may revert the impact of OSAS on the metabolic phenomena; however, patients do frequently (and unfortunately) maintain their body weight.Although not confirmed by all investigations, a tendency towards an improvement in some of the above-mentioned metabolic parameters has been reported in several studies in obstructive sleep apnoea syndrome patients and may be reflected by the decreased occurrence of new cardiovascular events, the reduction of systolic blood pressure and the improvement of left ventricular systolic function.
Analysis of emergency helpline support for home ventilator dependent patients: risk management and workload
Authors: Chatwin M. , Heather S. , Hanak A. , Polkey M. I. , Wilson B. , Simonds A. K. 
Published: September 2008

From a total of 1211 adult & paediatric patients receiving home ventilation (HV) supervised by Royal Brompton Hospital between 1/1/06 and 30/6/06 the respiratory support team received an average of 528 daytime calls/month and 14/month out of hours calls to a telephone helpline.Diagnoses included: neuromuscular disease, chest wall disease, COPD, obesity hypoventilation and non-COPD lung disease. 99% received non-invasive ventilation, 1% tracheostomy ventilation. 149 required 2 ventilators for near 24 hour ventilator dependency, the remainder were classified as 1 (17%) 2 (33%) & 3 (50%) night dependency as were able to breathe spontaneously for this period. 50% used bilevel positive pressure ventilators, 48% inspiratory pressure ventilators and 2% volume ventilators. In 188 calls a home visit was carried out because of ventilator or associated equipment-related problems. Despite regular equipment servicing programme, in 188 patients there was a technical problem with the equipment which was solved in the patient's home in 64% or required replacement / parts in 22%. Of the 25 calls in which no fault was found, 13 patients were unwell at home or required hospital admission, 2 patients died within 1 month of identification of no fault. No patient was admitted as a result of technical failure of equipment.Conclusion: There is a significant workload associated with supporting HV patients. Patients / carers all received standard competency training before discharge but other calls may be reduced by a more flexible problem-solving approach. Importantly, reports in which no technical fault is found may indicate deteriorating health in the patient and require close follow-up.
Activation of eosinophilsviaToll-like receptor (TLR)3, TLR7 and TLR9: link between viral infection and asthma?
Authors: Månsson Anne , Cardell Lars Olaf 
Published: September 2008

Asthma is disease characterized by a massive accumulation of eosinophils that release an array of tissue-damaging mediators. Respiratory viral infections are thought to be a leading cause of exacerbations of asthma. One possible explanation might be a direct activation of viral components through Toll-like receptors (TLRs), a receptor family comprising 10 different pathogen-recognizing members (TLR1-TLR10). The virus-recognizing TLRs are TLR3, TLR7/8 and TLR9, which respond to viral dsRNA, ssRNA and CpG-DNA. The present study aimed to investigate the expression of these TLRs and their functions in human eosinophils.Eosinophils were isolated from peripheral blood using magnetic beads (purity >97%). Cells were incubated with or without poly(I:C), R-837 or CpG alone, the synthetic ligands of TLR3, TLR7 and TLR9, respectively, or combined with IL-4 or histamine. Flow cytometry, and ELISA were used to analyze expression of TLRs and various surface markers, viability and secretion of inflammatory mediators.Eosinophils expressed proteins for TLR3, TLR7 and TLR9. Poly(I:C), R-837 and CpG prolonged survival, up-regulated expression of the adhesion molecule CD11b and increased secretion of IL-8 compared to unstimulated controls. These effects were affected by the presence of IL-4 and histamine.This study shows that several viral products directly activate eosinophils through their TLRs. Since eosinophils are central in asthma, the TLR system may be an important mechanism of eosinophil activation linking viral infections with exacerbations. Consequently, this system represents a future clinical target for the resolution of asthmatic disease.
Effects of pneumococcal vaccine in patients with chronic respiratory disease
Authors: Watanuki Yuji , Miyazawa N. , Kudo M. , Inoue S. , Goto H. , Takahashi H. , Kaneko T. , Ishigatsubo Y. 
Published: September 2008

In developed countries, it is very difficult to demonstrate the effectiveness of pneumococcal vaccines because the incidence of pneumococcal pneumonia is very low.Vaccination against pneumococci infection was advised for 1378 outpatients, over 60 years of age, with chronic respiratory disease for more than one year. Of these patients, those who responded affirmatively to the advice were vaccinated against pneumococci between August and November 2002. The effectiveness of vaccination was evaluated by means of a 2-year cohort-study, comparing the vaccinated group (647) with the non-vaccinated group (731). The variables analyzed were the frequency of onset of bacterial respiratory infection, hospitalization due to bacterial respiratory infection and onset of pneumococcal respiratory infection.The incidence of bacterial respiratory infection and the incidence of pneumococcal respiratory infection to have decreased in the following 2 years (17.4%, 0.9%), as compared to the previous year (25.9%, 3.1%), in the vaccinated group. Conversely, the frequency was higher in the following 2 years (14.4%, 0.9%) as compared to the previous year (14.2%, 0.4%) in the non-vaccinated group. This inter-group difference was statistically significant. Simultaneous vaccination against pneumococci and influenza virus also resulted in a significant reduction in the incidence of bacterial respiratory infection. No decrease was observed in the frequency of hospitalization.These results indicate that pneumococcal vaccine is useful for elderly patients with chronic respiratory disease and that its efficacy may be enhanced by simultaneous vaccination against influenza.
Managing asthma patients: which outcomes matter?
Authors: Greening A. P. , Stempel D. , Bateman E. D. , Virchow J. C. 
Published: September 2008

Within the respiratory specialist community, there is growing recognition that classification of asthma based on severity of symptoms alone may not accurately reflect the clinical status of a patient. It follows, therefore, that treatment decisions based on this classification can lead to suboptimal management of asthma.The concept of assessing patients by their level of asthma control is gaining wide acceptance and is a major component of the new 2006 Global Initiative for Asthma guidelines. Questions remain, however, on how best to achieve and maintain asthma control.Randomised controlled trials have shown that very good asthma control is achievable in the majority of patients. There is a need for a tool to accurately assess a patient's level of control in the clinical setting if such results are to be replicated in practice.A symposium at the European Respiratory Society Annual Congress in 2006 discussed the important issues that are currently facing asthma clinicians. The current article summarises the main points arising from that symposium.
Prevention of pulmonary vascular and myocardial remodeling by the combined tyrosine and serine-/threonine kinase inhibitor, sorafenib, in pulmonary hypertension and right heart failure
Authors: Klein M. , Schermuly R. T. , Ellinghaus P. , Milting H. , Riedl B. , Ghofrani H. A. , Grimminger F. , Schäfer S. 
Published: September 2008

Inhibition of tyrosine kinases can reverse pulmonary hypertension but little is known about the role of serine-/threonine kinases in vascular and myocardial remodeling. We investigated the effects of sorafenib, an inhibitor of the tyrosine kinases VEGFR, PDGFR and c-kit as well as the serine-/threonine kinase Raf-1, in pulmonary hypertension and right ventricular (RV) pressure overload.In monocrotaline treated rats, sorafenib (10 mg·kg−1·d−1p.o.) reduced pulmonary arterial pressure, pulmonary artery muscularization and RV hypertrophy, and improved systemic hemodynamics (table 1). Sorafenib prevented phosphorylation of Raf-1 and suppressed activation of downstream signaling pathways (Erk 1/2).After pulmonary banding, sorafenib, but not the PDGFR/c-KIT/ABL-inhibitor imatinib reduced RV mass and RV filling pressure significantly. Congruent with these results, sorafenib only prevented ERK phosphorylation and vasopressin induced hypertrophy of the cardiomyocyte cell line H9c2 dose dependently (IC50 = 300 nM).Combined inhibition of tyrosine and serine-/threonine kinases by sorafenib prevents vascular and cardiac remodeling in pulmonary hypertension, which is partly mediated via inhibition of the Raf kinase pathway.
The Oxford Transport Strategy: impact of a traffic intervention on PEF and wheeze among children
Authors: MacNeill S. J. , Goddard F. , Pitman R. , Tharme S. , Cullinan P. 
Published: September 2008

The Oxford Transport Strategy (OTS) was a major traffic intervention implemented in June 1999. It involved a wide range of permanent changes focused primarily on the city centre of Oxford (England).We aimed to assess the impact of OTS on peak expiratory flow (PEF) and respiratory symptoms among city schoolchildren.Between 1998 and 2000, 1389 children aged 6–10 years were visited 2–3 times a year for 5-day periods. On each day of each visit, we measured their PEF and enquired about respiratory symptoms including wheeze (n = 19260 child-days of data). Exposure to traffic pre and post-OTS was estimated by the change in modelled traffic on the street nearest the home.Pre-OTS traffic levels were relatively low compared to other major cities, but post-OTS changes in children's exposure varied considerably; from a drop of 11184 to an increase of 9240 vehicles/24hrs. Adjusted regression analyses showed a statistically significant improvement in PEF (beta = 5.71 L·min−1, 95% CI (3.28, 8.18)) and wheeze (OR = 0.80, 95% CI (0.69, 0.92)) post-OTS. The impact of OTS on PEF was greater among children living near roads where traffic decreased compared to those living where there had been an increase. This association was only found among children currently receiving treatment for asthma and those in socio-economic classes III–V.These results suggest that even in cities with relatively low traffic levels interventions can result in improvements in the respiratory health of children. These benefits may be especially pertinent to children with pre-existing respiratory problems and those from less affluent socio-economic backgrounds.
The Leuven experience with a dichotomy in Bronchiolitis Obliterans Syndrome (BOS) after lung transplantation revealed by azithromycin
Authors: Vanaudenaerde Bart , Vos Robin , Geudens Nele , Van Raemdonck Dirk , Dupont Lieven , Verleden Geert 
Published: September 2008

BOS is the most important cause of late mortality after LTx. Until 5 years ago, the prevalence was around 30% and 50%, 3 and 5 years after LTx. Introduction of azithromycin (AZI) improved the FEV1in 40% of BOS patients. AZI treatment may explain why in our center, the BOS prevalence at 3 years has decreased from 30% to 15% compared to the ISHLT registry. Opposed to the current belief about BOS, we hypothesize a dichotomy within BOS: Neutrophilic Reversible Allograft Dysfunction (NRAD) and fibropoliferative BOS (fBOS; table 1). This dichotomy is based on the discrepancy in AZI response and observations within our center consisting of clinical, biochemical and cellular (BAL) analysis.NRAD makes a re-evaluation of the BOS definition (irreversible FEV1decline, neutrophilic inflammation, fibroproliferation) indispensable. As it is reversible, NRAD should be excluded from BOS and accepted as innate (non-specific) inflammation and as an important risk factor for the development of BOS. So after exclusion of other complications such as acute rejection, infection, gastro-oesophageal reflux and after a trial with AZI, BOS will remain what it is now (the fBOS). This implements a re-evaluation of the neutrophilic inflammation, as it is a prerequisite for AZI responsiveness. BOS can then histologically be characterized as pure inactive OB, which is hardly responsive to any treatment.
Impact of viruses on airway diseases
Authors: Johnston S. L. 
Published: September 2008

There is strong epidemiological evidence that respiratory viral infections are associated with 80–85% of asthma exacerbations in children. There is less evidence in adults, but the available data suggest viruses are associated with around two-thirds to three-quarters of exacerbations in adults. These associations include severe exacerbations requiring hospitalisation. The most common viruses detected in these studies were rhinoviruses, accounting for two-thirds of viruses detected.Asthmatics have increased susceptibility to respiratory virus infection and have recently been shown to have profoundly defective interferon-β responses to virus infection, resulting in increased virus replication.Atypical bacterial infections are also associated with chronic asthma and asthma exacerbations and a recent study indicates antibiotic therapy active against atypical bacteria is effective in treatment of exacerbations. Recent data also indicates asthmatics are at increased risk of invasive pneumococcal disease, suggesting they may also have impaired antibacterial immunity.Research is urgently required to determine whether augmenting anti-infective immunity is beneficial in the treatment/prevention of asthma exacerbations. More recent data also implicates viruses in the majority of exacerbations of chronic obstructive pulmonary disease. Studies are also required investigating anti-infective host defence in chronic obstructive pulmonary disease.
Modulation of airway inflammation to prevent exacerbations of COPD
Authors: Solèr M. 
Published: September 2008

Exacerbations of chronic obstructive pulmonary disease (COPD) are periods in the chronic course of this disease with symptoms of intensified inflammation, induced in part by infections but also by noninfectious irritating mechanisms. Although these exacerbations seem to be linked to accelerated long-term disease progression and impaired quality of life, there are only limited preventive measures available, apart from smoking cessation.This article compares the effectiveness of different pharmacological treatments for the prevention of COPD exacerbations, including the oral bacterial lysate OM-85.Given the differences in the mechanism of action of the treatments discussed, this opens some hope for additive or potentiating effects with combined treatments, which will have to be studied in future controlled trials.
Effective communication with the patient: FIGURE 1.
Authors: Booker R. 
Published: September 2008

The chronic and slowly progressive nature of chronic obstructive pulmonary disease (COPD) can create difficulties in effective communication between healthcare provider and patient. Such barriers, which include the personal beliefs of both caregiver and patient, need to be understood and addressed if the aims of the consultation are to be met.Patients with COPD may feel guilty, depressed and angry about their condition. Many patients with COPD are elderly and/or from lower socio-economic groups, both of which pose challenges to the caregiver, as does the stigma the disease carries, which stems from its strong link with smoking.Humanity, respect and people orientation are vital to good communication with COPD patients. Physicians and nurses should try to avoid patient misunderstanding and uncertainty, involve the patient in decision-making and achieve a shared understanding (concordance), as well as encourage the patient to accept responsibility for the actions agreed. This should improve management decisions made by healthcare professionals and ensure a more satisfied patient. Greater patient satisfaction may improve concordance and so bring about better patient outcomes.
Patient adherence with COPD therapy
Authors: Rand C. S. 
Published: September 2008

Although there are very few published studies on adherence to treatment regimens in chronic obstructive pulmonary disease (COPD), the evidence that exists suggests that, as with asthma therapy, adherence is poor.Patient beliefs about COPD, as well as their motivation and expectations about the likelihood of success of medical interventions, can influence adherence rates. Other critical factors include the patient's understanding of their illness and therapy, and the complexity of the prescribed treatment regimen. Incorrect inhaler technique is also a common failing.When prescribing in primary or specialist care, healthcare professionals should address adherence as a vital part of the patient consultation. Improved patient education may also increase adherence rates.
Patient preference for and satisfaction with inhaler devices
Authors: Anderson P. 
Published: September 2008

Preference for and satisfaction with inhaler devices may be associated with improved clinical outcomes, but this has not been proven to date.A screened Medline search for papers on preference for inhaler devices produced 29 studies on a variety of devices, with Advair Diskus® and TurbuhalerTMfeaturing prominently. Of the 23 studies sponsored by the pharmaceutical industry, the sponsor's device was preferred in 19. Interpretation of results was made more difficult because only two studies used robust instruments for measuring preference and satisfaction. Patients with unstable disease or who were unable to use inhalers were usually excluded, and the extent of instruction and coaching given in the studies was greater than that seen in everyday practice. Studies found no significant differences in clinical outcomes between devices (where measured).Although inhaler preference is a valid patient-reported outcome deserving of scientific study, assessment and reporting of preference outcomes should follow the same regulatory standards as other patient-reported outcomes.
Cost of scheduled and unscheduled asthma management in seven European Union countries
Authors: Williams A. E. , Lloyd A. C. , Watson L. , Rabe K. F. 
Published: September 2008

Frequent need for emergency healthcare indicates poor asthma control and consumes resources that might be better spent on improved management. This study estimated the cost of scheduled and unscheduled healthcare for asthma in seven European Union (EU) countries.The occurrence of asthma-related healthcare resource use and asthma symptom severity were identified from a telephone sample of people with asthma in France, Germany, Italy, the Netherlands, Spain, Sweden and the UK. Healthcare resource use was multiplied by country-specific unit costs to estimate per patient annual expenditure. Patients were divided into four groups according to asthma symptom severity: mild intermittent symptoms, mild persistent symptoms, moderate persistent symptoms and severe persistent symptoms. Cost was divided between scheduled and unscheduled care. Drug cost was not evaluable.The study included 2,803 patients, of whom 1,695 (60%) reported mild symptoms and 2,050 (73%) were aged ≥16 yrs. The average annual per patient cost was €789 for patients aged 0–4 yrs, €463 for patients aged 5–15 yrs and €566 for adults. Unscheduled care accounted for 47% of total cost in infants, 45% in children and 56% in adults.Around half of expenditure on asthma management was found to be due to unscheduled care regardless of the severity of patient symptoms.