Florin Mihaltan

Anti-TNF-α therapies in chronic obstructive pulmonary diseases

Background: Chronic obstructive pulmonary disease (COPD) and asthma are chronic diseases in which inflammation of the airways leads to progressive transient airway obstruction and TNF-α plays an important pro-inflammatory role. Objective: To assess the plausibility of anti-TNF-α therapies playing an anti-inflammatory role in asthma and COPD. Methods: Scientific rationale of TNF-α targeting in asthma and COPD was assessed individually and the available data on the use of anti-TNF-α in each disease were reviewed. Results and conclusion: Anti-TNF-α therapies demonstrate different efficacies in asthma and COPD and further supportive preclinical and clinical data are needed, especially about subsets of certain diseases which could benefit the most from these therapies.

Outcome measures for palliative oxygen therapy: relevance and practical utility.

Dyspnea is a common symptom in many advanced malignant and non-malignant diseases and often is refractory to the usual therapies. In such circumstances palliative care approaches are necessary and among them palliative care oxygen therapy can be applied although currently its effectiveness is rather uncertain. Palliative oxygen therapy can be given on either continuous basis or on demand. Often the continuous palliative oxygen therapy is seen as long-term oxygen therapy although their aims are rather different. Palliative oxygen therapy was evaluated in populations with mixed underlying diseases, with outcome measures not only the most appropriate for the setting and therefore these limitations might have influenced the overall perceived therapeutic benefit. Therefore an evaluation of this method in subsets defined based on the etiology and pathogenic mechanisms and with appropriate outcome measures would help to better define the criteria for its indication and would increase its acceptability.

Different Valuations of COPD Treatment Goals Between General Practitioners and Pulmonology Specialists in a Real-World Evidence Study From Romania (ACORD)

PURPOSE: Chronic obstructive pulmonary disease (COPD) is a progressive disease with poor clinical outcomes if not appropriately treated. General practitioners (GPs) and pulmonology specialists are the pillars of the COPD care team. Little is known about the way the Romanian GPs and pulmonologists value the COPD treatment goals. The study ACORD aimed to evaluate the concordance of treatment goals between patients and physicians in COPD management in Romania and included both GPs and pulmonologists. We will present here the results for the two groups of physicians.

Efficacy of indacaterol as a single therapy versus salmeterol/fluticasone therapy in patients with milder chronic obstructive pulmonary disease

Introduction: In non-exacerbation chronic obstructive pulmonary disease (COPD) with mild lung function impairment, single bronchodilator therapy might be as effective as combined inhaled corticosteroid/bronchodilator therapy, whereas the risk of pneumonia associated with the latter would be practically absent. Areas covered: We performed an analysis of a recent study evaluating the efficacy and safety of inhaled indacaterol versus inhaled salmeterol/fluticasone in COPD patients. Expert opinion: Both therapies were found to exert comparable effects on lung function, symptom severity and health status.

The effect of CPAP on blood pressure in patients with OSAS and resistant hypertension followed 1 year

Objective: Few studies analyzed OSAS and resistant hypertension (RH) patients showing a reduction in blood pressure (BP) of 4-5mmHg for systolic (SBP) and 2-3mmHg for diastolic (DBP). We studied patients with moderate-severe OSAS (polysomograph recording, manual titration), compliant to CPAP therapy, monitored 48 hours ambulatory BP baseline, 3, 6 and 12 months. Methods: 35-65years old patients; exclusion criteria: insomnia, restless leg syndrome, parasomnias, secondary hypertension(HT), cardiovascular, respiratory, metabolic or acute uncontrolled pathologies, non-adherent to/changing antihypertensive medication. Results: 265 patients evaluated; 14 of 33 enrolled evaluated at 12 months: 9 men(64.3%), mean values: age 58.1±6.2 years, BMI 34.7±6.7kg/m 2 (similar at 1 year), Epworth 10.2±4.7/h, index of quality of life-SAQLI 4.8±1.6, diagnosis AHI 66.4±5.3/h, ODI 61.9±11.3/h, AHI post-titration 9.2 ±1.9, SBP baseline 161.7±22.1 mmHg, DBP 88.5±14.1 mmHg, diagnosed with HT for 12.8±11.3 years, CPAP compliance 87.9±14.1%, 5.9±1.1 h/night. After 1 year significant changes were recorded in almost all monitored parameters (except 48h average minimum BP both day and night), the decrease of BP: 23.9 mmHg for average/48h SBP and 12.0 mmHg for DBP. Conclusion: This study, included patients with uncontrolled severe RHT diagnosed for long time, is the first study that excluded other sleep associated pathologies with HT and followed patients for 1 year. We obtained significant reduction of BP superior to those previously reported in short term studies, highlighting the importance in terms of cardiovascular risk of proper CPAP therapy for a long period of time in these patients.

Nicotinic withdrawal rate assessment by applying minimal advice and measurement of CO in the exhaled air in smoking patients with tuberculosis

Tuberculosis is a global killer, claiming the lives of more than two million people annually and sickening millions more. Smoking increases the risks of becoming infected with tuberculosis, of developing the active form of disease and of dying from it. Therefore controlling the tobacco epidemic we will help control the TB epidemic. Clinicians should be more alert about reducing the TB risk among smokers by applying a simple medical intervention: minimal advice, short-term 3-5 min for quit smoking. A number of markers are available to assess the degree of compliance to a smoking cessation program. In this study we refer to: expired carbon monoxide (CO), Fagerstrom test, identification and analysis of the main barriers, nicotinic withdrawal rate. That TB risk could be reduced by nearly two-third if one quits smoking is a compelling evidence in highlighting the important role of smoking in TB control.