The First Symposium on COPD and Therapeutic Approaches 2016,Tehran,Iran
Esmaeil
Mortaz
author
Hamidreza
Jamatti
author
text
article
2017
eng
TANAFFOS (Respiration)
National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
1735-0344
16
v.
1(supplement)
no.
2017
https://www.tanaffosjournal.ir/article_242182_90606ba91a3ef7af77d2176678386d21.pdf
Role of Epigenetic Modifications in Pathology of COPD
Ian Michael
Adcock
National Heart& Lung Institute (NHLI), Imperial College London
author
text
article
2017
eng
The epigenome is a set of heritable modifications and tags that affect the genome without changing the intrinsic DNA sequence. These marks include DNA methylation, modifications to histone proteins around which DNA is wrapped and expression of noncoding RNA. Alterations in all of these processes have been reported in patients with COPD. In some cases these differences are linked to disease severity and susceptibility and may account for the limited value of genetic studies in COPD. Animal models of COPD suggest that epigenetic modifications and processes are linked to COPD and may be tractable targets for therapeutic intervention
TANAFFOS (Respiration)
National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
1735-0344
16
v.
1(supplement)
no.
2017
https://www.tanaffosjournal.ir/article_240185_0e8cf207a5e04098c88b206441948d65.pdf
Update Pathogenesis of COPD
Ian Michael
Adcock
National Heart& Lung Institute (NHLI), Imperial College London
author
text
article
2017
eng
The immunopathology of chronic obstructive pulmonary disease (COPD) is based on the innate and adaptive inflammatory immune responses to the chronic inhalation of cigarette smoking. In the last quarter of the century, the analysis of specimens obtained from the lower airways of COPD patients compared with those from a control group of age-matched smokers with normal lung function has provided novel insights on the potential pathogenetic role of the different cells of the innate and acquired immune responses and their pro/anti-inflammatory mediators and intracellular signalling pathways, contributing to a better knowledge of the immunopathology of COPD both during its stable phase and during its exacerbations. This also has provided a scientific rationale for new drugs discovery and targeting to the lower airways. This review summarises and discusses the immunopathology of COPD patients, of different severity, compared with control smokers with normal lung function
TANAFFOS (Respiration)
National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
1735-0344
16
v.
1(supplement)
no.
2017
https://www.tanaffosjournal.ir/article_240186_e447a326bb7dd19d1db3a4c830fe7a0d.pdf
“Mild” COPD: What Spirometry Conceals!
Denis E.
O’Donnell
author
text
article
2017
eng
COPD is a common inflammatory disease of the airways, alveoli and microvasculature that is under-diagnosed in smokers at risk for the disease. The majority of COPD patients have mild airway obstruction. Symptomatic smokers with mild COPD are at higher risk for earlier mortality and poorer perceived quality of life than non-smokers. Moreover, dyspnoea and activity restriction are common among smokers with minor spirometric abnormalities. Tobacco-related inflammatory injury of the lungs manifests as heterogeneous physiological impairment with highly variable clinical expression. Thus, simple spirometry provides only a crude assessment of disease pathophysiology, especially in the early stages of the disease. Several studies have shown consistent physiological abnormalities on oscillometry, together with abnormal configuration of the mid-volume maximal expiratory flow-volume loop and increased pulmonary gas trapping, which collectively point to the presence of extensive small airway dysfunction despite FEV1, plethysmographic lung volumes and resting inspiratory capacity being within the normal range. Recent exercise studies in symptomatic smokers with or without mild COPD have highlighted that exercise limitation is common and is multifactorial but that respiratory factors such as increased dynamic mechanical constraints are contributory. Lung microvascular inflammation, disruption of the alveolar-capillary interface and reduced pulmonary perfusion are increasingly identified in smokers with minor spirometric abnormalities. In this context reduced ventilatory efficiency during exercise (high VE/VCO2 nadir) is common in mild COPD and mainly reflects high physiological dead space (rather than alveolar hyperventilation or reduced VT) and thus a preponderance of lung units with high ventilation-perfusion ratios. This presentation explores the clinical consequences of this heterogeneous physiological impairment in smokers with unremarkable spirometry.
TANAFFOS (Respiration)
National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
1735-0344
16
v.
1(supplement)
no.
2017
https://www.tanaffosjournal.ir/article_240187_0185e4ea55e771745ba84c258e43a070.pdf
Activity-Related Dyspnoea in Chronic Pulmonary Diseases: New Mechanistic Insights
Denis
E. O’Donnell
author
text
article
2017
eng
Activity-related dyspnoea is the most common symptom of patients with chronic lung diseases and underpins perceived poor health status. Our understanding of the nature and source of dyspnoea continues to grow but successful amelioration of this distressing symptom can remain elusive, especially in those with advanced lung diseases. According to Norman Jones, the great Canadian physiologist, “breathlessness can be seen to result from an imbalance between the demand for breathing and the ability to achieve the demand.” Indeed, in most clinical situations where patients report severe dyspnoea, ventilatory demand-capacity imbalance is present. Thus, in patients with chronic lung conditions, ventilatory demand reaches or exceeds maximal ventilatory capacity (MVC) during physical exertion. Similarly, the ratio of respiratory muscle effort (measured by esophageal manometry) to maximal possible respiratory effort is increased at a given work rate or ventilation in patients with lung disease versus healthy controls.
TANAFFOS (Respiration)
National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
1735-0344
16
v.
1(supplement)
no.
2017
https://www.tanaffosjournal.ir/article_240188_893b95dd8181baba39d5cd43bab63af8.pdf
Pulmonary Rehabilitation for COPD
Nicholas
Hopkinson
NIHR Respiratory Biomedical Research Unit at Royal Brompton and Hare field HNS Foundation Trust and Imperial College London
author
text
article
2017
eng
Given finite healthcare resources it is important to ensure that they are put to the best use. Value in health care represents the relationship between health outcomes achieved and resources used. In a highly prevalent condition it is important to ensure that the highest value interventions are employed effectively In COPD these are influenza vaccination, smoking cessation and pulmonary rehabilitation (www.impressresp.com)(1,2). Skeletal muscle impairment is a common and important feature of respiratory disease. In COPD it is associated with reduced quality of life (3), exercise capacity and survival (4). Muscle endurance is also reduced and this has been confirmed using non-volitional techniques (magnetic femoral nerve stimulation) (5). Muscle fatigue is an important symptom limiting exercise (6).The main driver is physical inactivity and this occurs in early in the course of the disease (7) in particular this may be before it has been diagnosed (8). Physical inactivity may itself drive lung disease progression (9). As well as a loss of muscle bulk there is a shift away from a Type I fibre, oxidative endurance muscle phenotype (10). The underlying biology is complex and in addition to inactivity, inflammation, corticosteroids, reduced anabolic hormones, corticosteroid treatment, hypoxia, poor nutrition and increased resting energy expenditure may all play a role (11). There is a recent ATS/ERS statement on limb muscle dysfunction in COPD (12). Exercise has a wide range of beneficial effects. It can improve exercise capacity, lipid profile, reduce falls, reduce cardiac risk, improve depression, insulin sensitivity, and systemic inflammation as well as protecting against cognitive decline and osteoporosis.
TANAFFOS (Respiration)
National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
1735-0344
16
v.
1(supplement)
no.
2017
https://www.tanaffosjournal.ir/article_240189_06ba8d0a204aff0e5f9448528875fa45.pdf
Lung Volume Reduction in Advanced Emphysema
Nicholas
S Hopkinson
NIHR Respiratory Biomedical Research Unit at Royal Brompton and Harefield NHS Foundation Trust and Imperial College London.
author
text
article
2017
eng
Hyperinflation is a cardinal feature of COPD associated with reduced daily physical activity (1) and increased mortality (2). Although bronchodilators and pulmonary rehabilitation have some effect many patients with COPD remain highly symptomatic (3,4). The most established treatment is lung volume reduction surgery and results from the NETT trial show improved survival in appropriately selected patients with upper lobe predominant disease and low exercise capacity (5) which are sustained out to at least 7 years (6). There is a Grade A evidence for LVRS in ARTS/ERS COPD guidelines and patients should be being systematically assessed for potential suitability. The risk of adverse outcomes in modern practice appears to be less than in the NETT.7 The cost/QALY of LVRS is between $40,0000 and $50,000 (8). Various other techniques are being assessed either to reproduce the effects of surgery with potentially fewer side effects or to enable lung volume reduction in different populations. Endobronchial valves prevent air entering a target lobe causing atelectasis and improving the function of other areas of lung. They do not work in the presence of interlobar collateral ventilation (9,10) which occurs if the interlobar fissures are not intact. The BeLieVeR-HIFi (10) and Dutch STELVIO (11) studies have shown that valve placement improves lung function, exercise capacity and quality of life. They reduce dynamic hyperinflation (12), improve oxygen kinetics (13) and chest wall synchrony (14) and may produce a survival benefit (15-17) The estimated cost per QALY of endobronchial valves is 25,000 Euros (18) Airway coils tension the target area of lung preventing airway collapse and have shown promise in early results (19) although sustained effects are modest (20-22). Other approaches are the use of steam to shrink target areas through contraction fibrosis (23) and the use of fibrin glue (24). Airway bypass techniques should work in the presence of collateral ventilation but are limited by problems keeping them patent, so benefit is very short-lived (25). As the evidence base and experience with patient selection for different therapies develops it is important for patients with potentially treatable emphysema to be discussed in a multidisciplinary meeting including chest physicians, radiologists and surgeons.
TANAFFOS (Respiration)
National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
1735-0344
16
v.
1(supplement)
no.
2017
https://www.tanaffosjournal.ir/article_240190_d3998ea9e071aece9e25274c4ce1c733.pdf
Impact of Air Pollution on COPD; Underlying Mechanisms
Hasan
Bayram
University of Gaziantep, Turkey
author
text
article
2017
eng
Epidemiological studies have demonstrated that there is an association between increases in air pollution and cardiopulmonary mortality and morbidity. Multi-centre studies in North America and Western European countries reported that an increase in the levels of particulate matter (PM), ozone, nitrogen oxides (NOx) and sulphur dioxide (SO2) leads to increases in prevalence, emergency room visits and hospitalization due to chronic respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD). In our recent studies, we investigated mechanisms underlying pollutantsinduced effects on airways of COPD patients. We cultured airway epithelial cell lines, and primary bronchial epithelial cells (BECs) from non-smokers, smokers with and without COPD, and investigated effects of diesel exhaust particles (DEP), which constitute the major fraction of particulate air pollution, on inflammatory mediator expression and viability and proliferation of these cells. Although DEP generally induced A549 alveolar epithelial cell viability, on contrary these particles inhibited the viability of BEAS-2B bronchial epithelial cells and primary BECs. Looking for the underlying mechanisms, we observed that DEP suppressed apoptosis of A549 cells, while inducing the apoptosis of BEAS-2B and primary BECs. Our real time-polymerase chain reaction (RT-PCR) studies demonstrated that DEP modulate mRNA expression of proteins regulating cell proliferation and apoptosis. Furthermore, DEP affected protein release and mRNA expression of inflammatory cytokines such as interleukin (IL)-8 and granulocyte macrophage colony stimulating factor (GM-CSF). This effect was modulated by Nacteylcysteine, and the inhibitors of cell signalling pathways. Our findings suggest that DEP may play a role in the pathogenesis of chronic pulmonary diseases such as COPD, by modifying viability, apoptosis, cytokine release and cell proliferation and apoptosis regulating proteins of BECs and alveolar epithelial cells.
TANAFFOS (Respiration)
National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
1735-0344
16
v.
1(supplement)
no.
2017
https://www.tanaffosjournal.ir/article_240191_aa60cbda2631e6a76b7e68b2e7f7beef.pdf
Does Noninvasive Ventilation Have a Role in Severe COPD?
Nicholas
S Hill
Tufts Medical Center, Boston, MA USA
author
text
article
2017
eng
Noninvasive ventilation (NIV) has long been theorized to offer benefit to patients with severe COPD. More than 30 years ago, nocturnal NIV (including negative pressure ventilators) was shown to reduce PaCO2 levels and improve respiratory muscle strength in such patients. The theories proposed that NIV would rest respiratory muscles at night, permitting improved strength and function during the daytime/ Others theorized that NIV might also improve the quality and quantity of sleep at night by preventing increases in PaCO2 and associated sleep fragmentation. Many investigations have been performed subsequently to test these theories and until recently most showed no significant or marginal benefit. On average, it appeared that those most likely to benefit had more CO2 retention; PaCO2 > 50 mm Hg. In recent years, several studies have shown more encouraging results, although there are still conflicting findings. A retrospective study from Philadelphia showed a dramatic reduction in hospital readmissions and mortality in patients treated with nocturnal NIV after hospitalizations for acute respiratory failure. Patients in the NIV group were more obese and had more OSA than those in the non-NIV group. A randomized controlled trial from Germany using higher intensity inspiratory pressures also showed a significant reduction in mortality. More recently, the HOT HMV study from the UK presented preliminary results at the ERS meeting in London this year, showing a reduction in hospital readmissions and improved mortality. However, a Belgian trial published 2 years ago showed no benefit of NIV in patients, including no reduction in readmissions. The lecture will attempt to shed light on the controversies in this field and make recommendations on where best to use NIV for severe COPD.
TANAFFOS (Respiration)
National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
1735-0344
16
v.
1(supplement)
no.
2017
https://www.tanaffosjournal.ir/article_240192_f7e8a76840729e5e00fee187248f07db.pdf
High Flow Nasal Cannula, Is There a Role in COPD?
Nicholas
S Hill
Tufts Medical Center, Boston, MA USA
author
text
article
2017
eng
High Flow Nasal Cannula refers to the delivery of gas intra-nasally via loose-fitting cannulae at flows up to 60 l/min and with FIO2 that can be varied between room air and 100%. The modality is generally well tolerated because the nasal cannulae are comfortable and the gas is heated and humidified to body temperature and saturation. In addition, it doesn’t interfere with speech or eating. Physiologically, it has a number of advantages over standard oxygen, including the humidification that enhances ciliary action and secretion removal, high inspiratory flow that cuts down on entrainment of room air, thus ensuring a more reliable delivery of a targeted FIO2, flushing out of upper airway dead space that improves efficiency of ventilation, reduction of respiratory rate that helps to cut down on work of breathing per minute, and a small amount of positive end expiratory pressure that may help to counterbalance auto-PEEP. In addition, it is clearly better tolerated than either standard mask oxygen delivery systems or noninvasive ventilation.
TANAFFOS (Respiration)
National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
1735-0344
16
v.
1(supplement)
no.
2017
https://www.tanaffosjournal.ir/article_240193_4b24ea7754bdb20134830fda9ef7856d.pdf
The Air We Breathe: Effect of Environmental Exposures on COPD
Jennifer
Quint
National Heart and Lung Institute, Imperial College London
author
text
article
2017
eng
TANAFFOS (Respiration)
National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
1735-0344
16
v.
1(supplement)
no.
2017
https://www.tanaffosjournal.ir/article_242174_374dd581568dac76f981cfeb5f8bb1c6.pdf
The Relationship between COPD and Cardiovascular Disease
Jennifer
Quint
National Heart and Lung Institute, Imperial College London
author
text
article
2017
eng
TANAFFOS (Respiration)
National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
1735-0344
16
v.
1(supplement)
no.
2017
https://www.tanaffosjournal.ir/article_242175_4185048db4b518123d32bc331dde6d48.pdf
Asthma, COPD & ACOS: -Omics Approach to Refine Treatable Traits in These Conditions
Kian Fan
CHUNG
National Heart & Lung Institute, Imperial College, London UK
author
text
article
2017
eng
TANAFFOS (Respiration)
National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
1735-0344
16
v.
1(supplement)
no.
2017
https://www.tanaffosjournal.ir/article_242176_7fc2635803bff21174b082b470d4f670.pdf
Mitochondrial Dysfunction as a Therapeutic Target in COPD
Kian Fan
CHUNG
National Heart & Lung Institute, Imperial College, London UK
author
text
article
2017
eng
TANAFFOS (Respiration)
National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
1735-0344
16
v.
1(supplement)
no.
2017
https://www.tanaffosjournal.ir/article_242177_abc70dc75ad740eef4cbb5360c5a8fbe.pdf
Neutrophil Priming in COPD Patients by Bronchitis Visualized by CT-Scans
Leo
Koenderman
Department of Respiratory Medicine and Radiology, University Medical Center Utrecht, The Netherlands.
author
Adele Lotamloi.
Esther Pompe
Department of Respiratory Medicine and Radiology, University Medical Center Utrecht, The Netherlands.
author
Firdaus Mohamed
Hoesein
Department of Respiratory Medicine and Radiology, University Medical Center Utrecht, The Netherlands.
author
text
article
2017
eng
TANAFFOS (Respiration)
National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
1735-0344
16
v.
1(supplement)
no.
2017
https://www.tanaffosjournal.ir/article_242178_fab1fd39efbd171f66d2390645c33ad9.pdf
Eosinophilic COPD: a Separate Disease Phenotype Warranting Specific Treatment
Leo
Koenderman
Department of Respiratory Medicine, University Medical Center Utrecht, The Netherlands.
author
text
article
2017
eng
TANAFFOS (Respiration)
National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
1735-0344
16
v.
1(supplement)
no.
2017
https://www.tanaffosjournal.ir/article_242179_4804110712d04af8a99f0fee874f658d.pdf
The Asthma COPD Overlap Syndrome: ACOS. Epidemiology and Historical Perspective
Maarten van
den Berge
Department of Pulmonary diseases, University Medical Center Groningen, University of Groningen, Groningen, the Netherland.
author
text
article
2017
eng
TANAFFOS (Respiration)
National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
1735-0344
16
v.
1(supplement)
no.
2017
https://www.tanaffosjournal.ir/article_242180_5d97b847a067c1eaabee4dfbcfc809de.pdf
Effect of Global Climate Change-Related Factors on COPD Morbidity
Hasan
Bayram
University of Gaziantep, Turkey,
author
text
article
2017
eng
TANAFFOS (Respiration)
National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
1735-0344
16
v.
1(supplement)
no.
2017
https://www.tanaffosjournal.ir/article_242181_80d9c591a9bca6a59990d182ba9147a2.pdf