Ruxandra Ulmeanu

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.

Bronchoalveolar lavage fluid cellular profile in workers exposed to chrysotile asbestos.

The cellular profile of bronchoalveolar lavage fluid (BALF) in asbestos-exposed population remains controversial. We, therefore, aimed to investigate BALF in apparently healthy individuals that were exposed in asbestos-related work for a long period of time. Participants were selected among employees of a car brakes and clutches factory that used chrysotile asbestos. Selection criteria were an employment history of ≥15 years and the absence of severe respiratory disease. The total number and type of BALF cells, the existence of dust cells, iron-laden macrophages and asbestos bodies were assessed. Thirty-nine workers (25 men), with a mean age of 46.2 ± 4.2 years and a mean employment time of 23.5 ± 4 years, participated. Asbestos bodies were observed in 14 out of 39 (36%) specimens, dust cells in 37 and iron-laden macrophages in all. Those with asbestos bodies had at least 3 times higher probability to have lymphocytosis (lymphocytes > 11%: 64% vs 28%, p = 0.027) and had an increased percentage of iron-laden macrophages compared to those without asbestos bodies (median values: 42% vs 13%, p = 0.08). Smokers (36%) had less lymphocytes compared to non and ex-smokers (median values: 6% vs. 13%, p = 0.002), and iron-laden macrophages count had a positive relation (r = 0.31, p = 0.05) to lymphocyte count. Asbestos-exposed asymptomatic individuals with the presence of asbestos bodies in the BALF are more likely to have lymphocytic alveolitis while concurrent dust exposure and smoking habits hold a significant role.

Nivolumab for advanced non-small cell lung cancer: an evaluation of a phase III study

ABSTRACT Lung cancer still remains associated with a high mortality rate and more efficacious therapies are needed in order to improve the disease outcome. Nivolumab is a monoclonal antibody which blocks the programmed death-1 receptor which is currently evaluated in phase III clinical trials in advanced lung cancer. Here, we evaluate the results of a phase III study in which nivolumab efficacy and safety were compared to those of docetaxel. Nivolumab was able to improve survival and progression-free survival and exhibited a very good safety profile. Further clinical data are needed in order to better position this therapy among the existing methods. The promising results support the use of this therapy as a stand-alone approach.

Nivolumab for advanced non-small cell lung cancer: an immunologically-mediated tumor checkout

Non-small cell lung cancer (NSCLC) is associated with high mortality especially in the most advanced stages and when tumor is not responsive to the first line, conventional platinum-based chemotherapy or to newer compounds such as pemetrexed or erlotinib. Therefore newer agents with different mechanisms of action are needed and nivolumab is a relevant example of the kind.

Combined long-acting bronchodilator single therapy for COPD

Introduction: In COPD, the long-acting bronchodilators are not always able to provide an appropriate bronchodilator effect in terms of amplitude and duration and this can result in increased severity of respiratory symptoms and in worsening of health status. Combined long-acting bronchodilators can address this limitation. Areas covered: Analysis of a recent study evaluating the efficacy and safety of 26 weeks of therapy with glycopyrronium+indacaterol single inhaler (QVA149) versus each component, versus tiotropium and versus placebo. Expert opinion: Such a combination can provide a superior and sustained bronchodilator effect and can minimize the respiratory symptoms resulting from a suboptimally inhibited bronchoconstriction.

Asthma and pregnancy: therapeutic challenges

PurposeAsthma in pregnancy represents a complex therapeutic challenge as it can have unfavourable consequences on both the mother and the fetus. Pregnancy can have a variable impact on asthma, and there is no general rule to predict in whom is going to be better, stable or worse. On the other hand, asthma can increase the risks of fetal malformations, low birth weight or premature birth.Methods and resultsThe review of the literature regarding the asthma pathogenic maternal and fetal effects and the current therapeutic recommendations.ConclusionsA multidisciplinary team is needed to appropriately follow up a pregnant woman with asthma and this should involve a pulmonary disease physician, a neonatologist, an obstetrician and, if necessary, an allergolocist. Most of the medications used in asthma outside pregnancy can safely be used during it. An appropriate management according to existing guidelines can minimize both maternal and fetal risks.

Inhaled therapies in patients with moderate COPD in clinical practice: current thinking

COPD is a complex, heterogeneous condition. Even in the early clinical stages, COPD carries a significant burden, with breathlessness frequently leading to a reduction in exercise capacity and changes that correlate with long-term patient outcomes and mortality. Implementation of an effective management strategy is required to reduce symptoms, preserve lung function, quality of life, and exercise capacity, and prevent exacerbations. However, current clinical practice frequently differs from published guidelines on the management of COPD. This review focuses on the current scientific evidence and expert opinion on the management of moderate COPD: the symptoms arising from moderate airflow obstruction and the burden these symptoms impose, how physical activity can improve disease outcomes, the benefits of dual bronchodilation in COPD, and the limited evidence for the benefits of inhaled corticosteroids in this disease. We emphasize the importance of maximizing bronchodilation in COPD with inhaled dual-bronchodilator treatment, enhancing patient-related outcomes, and enabling the withdrawal of inhaled corticosteroids in COPD in well-defined patient groups.

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.

The risk of pneumothorax in ultrasonographic guided transthoracic lung biopsy

Transthoracic lung biopsy is a relatively frequently performed procedure,using CT or ultrasound as guidance,most commonly use being CT guide. Ultrasonographic (US) guidance in transthoracic lung biopsy (TLB) is harmless, cheap, and easy to use.Common complications are pneumothorax, hemoptysis, hemothorax, infection, and air embolism. Aim: To evaluate the incidence of pneumothorax in ultrasonographic guided transthoracic lung biopsy, on the patients who underwent this investigation in the Department of Pneumology , Municipal Clinical Hospital Oradea, between Jan. 2015-Jan. 2016. Method: Between Jan. 2015-Jan. 2016, 89 patients, with peripheral lung tumors, were hospitalized at the clinique. From the 89 patients, 59(66,29%) patients had a peripheral lung tumors that was approachable by chest ultrasound. We performed 59 transthoracic lung biopsies guided US and no CT guided biopsy. The patients were monitored immediately post procedure by Chest US at 3h, 8h and 24h. Variables such as age, gender, lesion size, location, presence of an emphysematous change, biopsy guidance methods, and biopsy devices were analyzed. Results: From 59 patients performed TBL, four patients(6,77%) had partial pneumothorax post TBL,immediately after biopsy. The pneumothorax volume was assessed by the lung ultrasound, in all cases being a small volume Conclusion: Pneumothorax incidence related TBL US guided was 6,77%,wich is lower than general incidence 8-61% reported in the literature. We have only small pneumothorax as complication of TBL US guided,and 0% needed chest tube insertion.