This document discusses various treatment options for bronchial asthma and COPD, including short-acting beta agonists, long-acting beta agonists, inhaled corticosteroids, anticholinergics, antileukotrienes, IGE antagonists, PDE inhibitors, and anti-inflammatory drugs. It also discusses smoking cessation options like varenicline, nicotine vaccines, and rimonabant. New long-acting bronchodilators discussed include indacaterol, aclidinium bromide, and NVA237. Combination therapies involving inhaled corticosteroids and long-acting beta agonists are also summarized.
The latest guidelines on the management of a COPD patient ( Stable COPD, patient with an exacerbation of COPD), latest modalities of treatment of a COPD patient
The latest guidelines on the management of a COPD patient ( Stable COPD, patient with an exacerbation of COPD), latest modalities of treatment of a COPD patient
Chronic Obstructive Pulmonary Disease (COPD) by Dr Kemi DeleKemi Dele-Ijagbulu
Presentation on definition and general overview of COPD, how to differentiate COPD from Asthma, how to make diagnosis of COPD, simple tools for assessment of COPD; available therapeutic options; as well as management of stable COPD, COPD exacerbations and comorbidities
At the end of this lecture student able to:
Define COPD
List causes of COPD
List risk factors of COPD
List signs and symptoms of COPD
List diagnostic measures
Describe treatment of COPD
Identify complications of COPD
Use nursing process
Discuss relevant patient / family education
Chronic Obstructive Pulmonary Disease BY
Dr Akram Yousuf
Resident Internal Medicine
Liaquat University of Medical Health and Sciences Jamshoro Pakistan
My all and slides mostly try to simplify pharmacy knowledge. Any time you are free to connect me. It's my pleasure to help you to get simplified pharmacy concepts. You may suggest topics needs to simplify the terminolog
Chronic Obstructive Pulmonary Disease (COPD) by Dr Kemi DeleKemi Dele-Ijagbulu
Presentation on definition and general overview of COPD, how to differentiate COPD from Asthma, how to make diagnosis of COPD, simple tools for assessment of COPD; available therapeutic options; as well as management of stable COPD, COPD exacerbations and comorbidities
At the end of this lecture student able to:
Define COPD
List causes of COPD
List risk factors of COPD
List signs and symptoms of COPD
List diagnostic measures
Describe treatment of COPD
Identify complications of COPD
Use nursing process
Discuss relevant patient / family education
Chronic Obstructive Pulmonary Disease BY
Dr Akram Yousuf
Resident Internal Medicine
Liaquat University of Medical Health and Sciences Jamshoro Pakistan
My all and slides mostly try to simplify pharmacy knowledge. Any time you are free to connect me. It's my pleasure to help you to get simplified pharmacy concepts. You may suggest topics needs to simplify the terminolog
Turacoz Skill Development Program tells you about the medico-marketing, its objectives, ethics followed, and the unethical marketing practices in the healthcare industry.
Montair (Montelukast Sodium tablets) is used for the prevention and chronic treatment of asthma, exercise-induced bronchoconstriction (EIB), seasonal allergic rhinitis and perennial allergic rhinitis
Is There A Future For Triple Therapy In Copd Ph Rogueda 14 April 2011Philippe Rogueda
An extensive review of the potential of triple therapy in the treatment of COPD, spanning Clinical Trials, Clinical Practice, Commercial insight and Intellectual Property
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
How STIs Influence the Development of Pelvic Inflammatory Disease.pptx
Future directions in copd management
1.
2.
3.
4. What is the treatment of bronchial asthma? SABA LABA ICS Anticholinergics Antileukotriens IGE antagonists PDEI Anti-mediators Anti-inflammatory Interleukin antagonists Others
5. What is the treatment of COPD? SABA LABA ICS Anticholinergics Antileukotriens!!!!!!! IGE antagonists!!!!!!! PDEI Anti-mediators Anti-inflammatory Interleukin antagonists!!!!!!!! Others
6.
7. Onoue et al, Expert Opin. Drug Deliv. (2009) 6(8):793-811
12. The binding, however, greatly slows delivery of nicotine to the brain, reducing its addiction potential. Clinical trials with nicotine vaccine are currently underway, and early studies show promiseRennard, 2011
13.
14. FDA declined to approve rimonabant because of concerns for potential suicide riskRennard, 2011
15. LABA Long-Acting Beta-Agonist LABA LiberaAccademia Belle Arti LABA Lubbock Area Baptist Association LABA Latin American Business Association LABA Leicestershire Asian Business Association LABA Los Angeles Business Advisors LABA Lebanese Alliance for Breastfeeding Action LABA Litchfield Area Business Association LABA Los Angeles Bowling Association LABA Latin American Boxing Association LABA Lancaster Avenue Business Association LABA Laboratory Animal Breeders Association LABA A Chinese Festival in mid-January
20. Raghavan et al, Current Opinion in Pharmacology 2011, 11:204–210
21. Compared with placebo, NVA237, 50 mg (Novartis) used through DPI (breezhaler) showed significant and sustained bronchodilatory efficacy in patients with mild, moderate or severe COPD Fogarty et al, Respiratory Medicine (2011) 105, 337e342
24. LAMA Or LAAC Abbreviate as you can A title for a Tibetan teacher of the Dharma Los Angeles Modern Auctions Los Angeles Music Academy An animal Local Authority Members Association
29. Aclidinium is rapidly hydrolysed in human plasma, unlike other currently available antimuscarinics including tiotropium. This results in very low and transient systemic exposure, suggesting a reduced potential for class-related systemic side effectsDevelopmental Status UK: Phase III Clinical Trials EU: Phase III Clinical Trials US: Pre-registration (Filed) Genuair® is a multi-dose dry powder inhalation device
33. The maintenance use of inhaled corticosteroids has been shown in several trials to decrease the incidence of acute COPD exacerbations by 12–25%
34. This effect is more pronounced in patients with more severe disease and those with a history of recurrent exacerbationsHanania and Sharafkhaneh, 2009
38. Trials with cilomilast in COPD reported a reduction in inflammatory markers in bronchial biopsies (i.e. CD8+ T cells and CD68+ macrophages) and modest improvement in FEV1, quality of life and reduction in COPD exacerbation
39. The use of PDE-4 inhibitors during an acute exacerbation of COPD has not been evaluated
40. The anti-inflammatory effect of PDE4 inhibitors raises the possibility that they could alter the natural history of COPDHanania and Sharafkhaneh, 2009
41.
42. The sub-type PDE4D appears to be particularly important in mediating this response
43. Cilomilast has some selectivity for PDE4D. As a result, its maximally tolerated dose may be limited and may be sub-optimal.Cilomilast is 15mg twice oral tab(Ariflo, GSK)
44. Roflumilast, which is not selective among the PDE4 species, may be slightly more effective clinically in contrast to theophyllineRennard, 2011
45.
46. Based on the existing large body of clinical data, the efficacy of roflumilast is well established and the place of this type of compound in COPD therapy is quite well delineated.
47. However some other issues remain to be clarified, including the safety profile and the systemic anti-inflammatory effects of roflumilast in COPDAntoniu, International Journal of COPD 2011:6 147–155
48. Pooled analysis of two large 12-month studies confirms that roflumilast 500 µg once daily improves lung function, reduces COPD symptoms and the rate of moderate or severe exacerbations, and increases time to onset of moderate or severe exacerbations in patients with severe-to-very-severe COPD receiving concomitant LABAs. Bateman et al , ERJ, doi: 10.1183/09031936.00178710, 2011
49. Gross et al, COPD: Journal of Chronic Obstructive Pulmonary Disease,2010,7:141-153
50.
51. Other rare side effects include; insomnia, anxiety, nervousness, and depression, suicidal ideation
52. In doses > 100mg/kg, it has a pro-inflammatory properties.
53. Roflumilast has been evaluated as an inhaled formulation in a rat model of OVA-induced asthma and its anti-inflammatory and bronchodilator effects have been demonstrated.Antoniu, International Journal of COPD 2011:6 147–155
54.
55. While active orally, theophylline derivatives have been found to be locally irritating, although modestly effective as inhaled bronchodilators .
59. Furthermore, two more recent US clinical trials compared fluticasone/salmeterol (250/50 μg bid) to salmeterol (50 μg bid). Fluticasone/salmeterol combination, compared to salmeterol, reduced the rate of moderate to severe COPD exacerbation by 30% during the 1-year study follow-upHanania and Sharafkhaneh, 2009
60.
61. Rates of COPD exacerbations did not differ between the two study arms.
62. However, the fluticasone/salmeterol arm had a lower rate of systemic steroid-requiring exacerbation episodes while subjects on tiotropium had fewer antibiotic-requiring exacerbationsHanania and Sharafkhaneh, 2009
65. Relovair (fluticasonefuroate + vilanteroltrifenatate,GSK) Long-acting beta agonist (LABA) in combination with the once-a-day inhaled corticosteroid (ICS), fluticasonefuroate (FF) Developmental Status UK: Phase III Clinical Trials EU: Phase III Clinical Trials US: Phase III Clinical Trials
66.
67.
68. There is insufficient evidence to determine if triple therapy is superior to the LAAC + LABA treatment regimenGaebel et al, COPD: Journal of Chronic Obstructive Pulmonary Disease, 8:206–243, 2011
72. Pulmonary vasoconstriction serves to maintain ventilation-perfusion balance, and preserve oxygenation, pulmonary vasodilators also have the potential to worsen oxygenation.
73. Whether pulmonary vasodilator drugs will prove useful to treat patients with COPD remains to be determinedRennard, 2011
74. PDEI5 Inhibitors of PDE5, which catalyze the degradation of cyclic GMP, relax vascular smooth muscle. They may also reduce pulmonary arterial pressure and may have utility in pulmonary hypertension but whether improved cardiac output will be offset by worsening ventilation-perfusion matching by these agents (or any other pulmonary vasodilators) remains to be determined Rennard, 2011
75. ANTI-INFLAMMAORY DRUGS INFLAMMAORY DISEASE, BUT NO ANTI-INFLAMMAORY DRUG HAS A ROLE, EVEN IN THE NEAR FUTURE. THERE MUST A MISTKE, SURE THERE IS
76.
77. This is even more important, since exacerbations can also be significantly reduced by non anti inflammatory treatments, namely long-acting bronchodilators and lung volume reduction surgeryBeeh and Glaab, COPD: Journal of Chronic Obstructive Pulmonary Disease,2009, 6:395–403
78.
79. A recently published prospective study using infliximab in stable COPD patients failed to reveal any beneficial effects for this agent when used over six months
80. the long-term safety of this agent was questioned in this study, as the incidence of malignancy was higher in the treated patients compared with placeboHanania and Sharafkhaneh, 2009
81.
82. Each vial contains 100mg. Vial dissolved in 10ml sterile water and then dissolved in 250 ml 0.9% normal saline and infused in not less than 2 hours. Give H2 blocker and antihistaminic with or without steroids as premedications. Every 3-8 weeks
83.
84. Theophylline: A deficiency in HDAC2 has been reported in COPD patients. The ability of theophylline to increase HDAC2 activity, therefore, raises the possibility that theophylline may have an important anti-inflammatory action, particularly, in combination with glucocorticoidsRennard, 2011
85.
86. Selectins are the adhesion molecules that enable the attachment and “rolling” of leucocytes on the vascular endothelium, the first step in the neutrophil inflammatory response. Bimosiamose is taken daily by inhalation through a novel nebulizer device and is in two phase II studies. Gross, COPD: Journal of Chronic Obstructive Pulmonary Disease, 8:136–138, 2011
87.
88. In an accepted clinical model of ozone challenge, inhalation of Bimosiamose led to a broad and favorable significant anti-inflammatory effect.
89. Revotars latest cross-over Phase II study investigated the anti-inflammatory effect of Bimosiamose inhaled twice daily over four weeks. Treatment with Bimosiamose resulted in a broad anti inflammatory effect as well as a trend in lung function improvement in COPD patients.http://www.revotar.de/copd.htm, 28/7/2011
90.
91. Arriva has inhaled ilomastat “a potent, broad spectrum inhibitor of matrix metalloproteinases that has been shown to be active in an animal model of cigarette smoke-induced emphysema”.HunninghakeGM, et al. NEJM 2009;361:2599–608 Gross, COPD: Journal of Chronic Obstructive Pulmonary Disease,2010, 7:307–309
92.
93. NF-kB is activated in macrophages and epithelial cells of COPD patients. It regulates expression of chemokines like IL-8, TNF-α and other inflammatory cytokines, and some of the metalloproteinases.
94. NF-kB proteins are present in the cytoplasm in association with inhibitory proteins that are known as inhibitors of NF-kB (IκBs)Hanania and Sharafkhaneh, 2009
95.
96. However, IKK inhibitor did not reduced the inflammatory cell burden in COPD modelHanania and Sharafkhaneh, 2009
97.
98. It has a significant anti-inflammatory effect by suppressing NF-kB. The role of curcumin in COPD is not clear but is currently being evaluatedHanania and Sharafkhaneh, 2009
99. RESVERATROL Resveratrol (3,5,4’-trihydroxystilbene) is a polyphenolic molecule found in the skins of red fruits such as grapes, and is one of the compounds in red wine It has antioxidant, antineoplastic and anti-inflammatory properties Resveratrol inhibited both basal and stimulated cytokine release by bronchoalveolarlavage (BAL) fluid macrophages from cigarette smokers and patients with COPD The identification of its mechanisms of action and its role in COPD requires further study Hanania and Sharafkhaneh, 2009
100.
101. Importantly, several of the intermediates between mevalonate and cholesterol play an important role in regulation of signaling processes. It appears that statins, by inhibiting the production of mevalonate, may have anti-inflammatory actions patients treated with statins had lower risk of mortality as well as hospitalization.
102. This was true for both cardiac events and for COPD-related events
103. The same benefits, with lesser significance were found with ACEIs and ARBsRennard, 2011
104.
105. Improvements in pulmonary hemodynamics may represent an addition to the growing list of potential benefits of statin use in COPD.
106. In multiple regression analysis, statin use was associated with a 4.2 mmHg (95% CI: 2 to 6.4, p=<0.001) lower PAWP and a 2.6 mmHg (95% CI: 0.3 to 4.9, p=0.03) reduction in mPAP independent of PAWPReed et al, COPD: Journal of Chronic Obstructive Pulmonary Disease, 8:96–102, 2011
109. MK-0633, was in development by Merck and completed a phase II trial in late 2009. However, neither the primary outcome, trough FEV1 in the last week of a 12-week RTC, nor any of the secondary outcomes were different between treatmentsBernstein JA, et al. Respir Med. 2011;105:392-401
110.
111. Using montelukast, Significant improvements in FVC, FEV1, PaO2 and St. George’s Respiratory Questionnaire (SGRQ) scores (p < 0.05) were observed in the montelukast group with no comparable improvements in the placebo groupWoodruff et al, COPD: Journal of Chronic Obstructive Pulmonary Disease, 8:21–29, 2011
114. Similarly, there was no effect on rate of COPD exacerbations in the study as a whole. There was, however, a reduction in exacerbation frequency in subjects who were not concurrently treated with glucocorticoidsRennard, 2011
115.
116.
117. Sibenadet (ViozanTM), an agonist on the D2 dopaminergic receptor, works through this pathway and is also a beta2 agonist leading to cough suppression and bronchodilatation. This was not sustained in long term studiesRennard, 2011
123. Tesamorelin is undergoing a trial as a treatment for weight loss in severe COPDGross, Journal of COPD, The COPD Pipeline XI (August 2011)
124. Rivaroxban Rivaroxban is a once-daily oral direct factor Xa inhibitor that has been developed to avoid the need for regular INR measurements Gross, COPD: Journal of Chronic Obstructive Pulmonary Disease, 8:244–247, 2011
125.
126. However, a recent meta-analysis concluded that consistent evidence across multiple important outcomes which clearly demonstrates clinical benefit does not existHanania and Sharafkhaneh, 2009
129. The study is sponsored primarily by National Jewish Hospital and the primary outcome is the frequency of acute exacerbationsGross, COPD: Journal of Chronic Obstructive Pulmonary Disease, 8:244–247, 2011
133. Under general anesthesia, separate dual-lumen catheter instillations of a suspension of fibrinogen and a solution of thrombin are endobronchially placed in target airways, those that lead to hyperinflated lung regions Besides the expected lung volume changes, meaningful improvements in quality of life and 6-minute walk were obtained and maintained for 6 monthsCriner GR et al AJRCCM 2009; 179:791–8)
134. CELL THERAPY, STEM CELL AND NANOMEDICINE EVERY BREAK-THROUGH IDEA STARTED LIKE THIS THIS THE FUTURE MEDICINE
144. One possible mechanism to account for this difference would be the persistence of a stem/progenitor cell population capable of responding to retinoic acid and inducing the formation of new alveolar wall in rodents.
145. This raises the possibility that lung regeneration in the human may be facilitated by concurrent cell-based therapiesRennard, 2011