Biomedical subjects

Néstor A Molfino

Publications and source records attributed to Néstor A Molfino.

6 recordsLinked to original sources

PubMed2006

Chronic obstructive pulmonary disease: histopathology, inflammation and potential therapies.

Chronic obstructive pulmonary disease (COPD) is a major worldwide health burden with increasing morbidity, mortality and health care cost. It is a slowly progressive chronic inflammatory condition that affects the conducting airways (both large and small) and lung parenchyma. In COPD, inflammation is evident early on even in mild disease and increases with disease severity. Recent advances in our knowledge demonstrate, by comparison with asthma, the distinctive, "abnormal" or exaggerated inflammatory processes involved in the pathogenesis of COPD and thus identify novel therapeutic targets that could potentially impact on disease progression. The present review will focus on what is known of the abnormal inflammatory response of COPD in different regions of the conducting airways and lung. Novel, potentially promising approaches to therapy are presented.

Anti-Inflammatory Agents↗

PubMed2004

Genetics of COPD.

COPD is a complex mix of signs and symptoms in patients with chronic bronchitis and emphysema, diseases that largely result from cigarette smoking. Not all smokers, however, acquire COPD, and COPD can develop in nonsmokers. In the United States, COPD is currently the fourth leading cause of death. Surprisingly, there are no effective drug therapies for COPD that are able to significantly alter disease progression, and little is known of the underlying molecular mechanisms that are responsible for its occurrence. Candidate gene-association studies and linkage analyses have been reported for COPD patients. This review describes the genetic predisposition of healthy subjects or relatives of COPD patients to acquire COPD. In addition, the genetic bases of COPD with rapid decline of FEV1 are described, and the current genetic data that have been distilled from studies of COPD patients with a predominant emphysema phenotype, with chronic bronchitis phenotype, and with a response to bronchodilators are discussed.

Bronchitis↗

PubMed2004

Trends in pharmacotherapy for chronic airflow limitation in Argentina: 1992-2002.

Asthma and COPD mortality rates have decreased in Argentina. These trends might be the result of the way these conditions are being treated. The number of units for prescription and over-the-counter (OTC) drugs used to treat chronic airflow limitation in Argentina from 1992 through 2002 were analyzed. Units for drugs to treat chronic airflow limitation fell by 45% over the 11-year period (p < 0.0001) due to significant reductions for oral beta2-agonists (OBA) (down 73%), theophyllines (down 74%), oral steroids (OS) (down 66%) and inhaled short-acting beta2-agonists (ISABA) (down 28%). Market share for inhaled steroids (IS) increased from 2.6% to 11.7%, for inhaled ipratropium (IP) from 0.35% to 3.7%, for the combination of inhaled steroids with short-acting beta2-agonists (IS+ISABA) from 7.8% to 13%, and for inhaled IP combined with short-acting beta2-agonists (IP+ISABA) it increased from 1.7% to 7.3%. Inhaled long-acting beta2-agonists (ILABA) and leukotriene modifiers (LM) were rarely prescribed. The use of more specific inhaled therapies (IS, IP) increased significantly in accordance with recommendations for the treatment of asthma and COPD and this may explain the reduction in asthma and COPD mortality in Argentina.

Adrenergic beta-Agonists↗

PubMed2004

[Treatment of patients with chronic obstructive pulmonary disease (COPD) by primary care physicians].

A number of recommendations for the treatment of chronic obstructive pulmonary disease (COPD) present the different therapeutic alternatives according to the severity of the condition. It is not entirely clear when the generalist should consult the specialist. This can be important particularly when the health care system is centered in the role of generalists and lack of clarity may be a factor in the deficient use of recommendations. The purpose of this review is to provide evidence of the efficacy and effectiveness for therapeutic approaches distilling from randomized controlled trials, observational trials and guidelines or meta-analyses. The emphasis is on the identification of clinical and physiological criteria that generalists should use to identify candidates for possible consultation with specialists.

Bronchodilator Agents↗

PubMed2002

Use of intravenous pulsed cyclophosphamide in severe, generalized myasthenia gravis.

Twenty-three myasthenia gravis (MG) subjects, mean (SD) age 41.6 years (14), showing poor disease control or steroid-related side effects, received treatment for 12 months with intravenous cyclophosphamide (CP; n = 12) or placebo (PL; n = 11) in a randomized, double-blind trial. Pulses were given monthly at an initial dose of 500 mg/m(2) of body surface, and titrated according to changes of peripheral muscle strength or side effects. Changes of muscle strength, steroid and pyridostigmine requirements, and development of ventilatory failure or swallowing impairment were evaluated at 0, 3, 6, and 12 months. No differences were observed between groups at baseline. Statistically significant reductions of methylprednisone doses were noted in both groups but were more pronounced in subjects receiving CP than PL at 6 months (P < 0.05) and at 12 months (P < 0.03). At 12 months, five subjects on CP had tapered off their steroids whereas no subject on PL achieved further reductions (P < 0.03). Four CP subjects were not receiving steroids 36 months after completing the study and three other CP subjects had stopped pyridostigmine. CP improved muscle strength at 3 and 6 months, and this reached statistical significance compared to PL at 12 months mainly in the bulbar and masticatory (P < 0.009) and extraocular muscles (P < 0.03). Ventilatory failure was noted in one subject on CP (due to bronchopneumonia) and two on PL (due to muscle weakness). No significant increases of CP-related side effects were observed. Thus, this study suggests that intravenous pulses of CP allow reductions of systemic steroids usage without muscle strength deterioration or CP-related side effects.

Acute Disease↗

PubMedDate not supplied

Drugs in clinical development for chronic obstructive pulmonary disease.

Many drugs may be potentially useful in the treatment of chronic obstructive pulmonary disease (COPD), but relatively few become available for human use due to lack of safety, lack of efficacy, or both. This is an inherent risk in the drug development process, which coupled with the limited understanding of the molecular pathogenesis of COPD, has produced a trend toward improving existing compounds rather than to develop new compounds. This review focuses on improved existing compounds and newly discovered compounds that are in clinical trials, but not yet marketed. The improved existing compounds include: isomers of the long-acting bronchodilators, once-daily beta2-adrenoceptor agonists, anticholinergics and corticosteroids. The pool of novel compounds is in constant fluctuation and comprises anti-inflammatory drugs, antioxidants, leukotriene modifiers and a number of compounds aimed at treating different aspects of COPD such as pulmonary hypertension and hypophosphatemia.

Administration, Inhalation↗