Pulmonology

The GINA 2023 Report: What’s new in asthma management?

The Global Initiative for Asthma (GINA) publishes a global strategy for asthma prevention and management that is updated every year based on a review of new evidence. Key changes in the GINA 2023 strategy report, published in May 2023, include treatment strategies for adults and adolescents to reduce the risk of severe exacerbations and minimise adverse effects, the writing of an asthma action plan for patients on different treatment regimens, and how to reduce the environmental impact of asthma and its treatment.

Modern Medicine – Issue 2 2024

Mucus Hypersecretion Opens the Door to Worsening COPD

Patients with chronic obstructive pulmonary disease (COPD) exhibit airway mucus hypersecretion, including sputum production, increased luminal mucus, goblet cell hyperplasia and submucosal gland hypertrophy. These processes have been shown to contribute significantly to morbidity and mortality in patients with COPD, especially in older patients and those who are prone to respiratory tract infection. N-acetylcysteine is a classic antioxidant that can reduce mucus viscosity and promote mucus discharge.

Modern Medicine – Issue 2 2023

Stem the Tide of Mucus Hypersecretion

Airway mucus hypersecretion is an important pathophysiological and clinical manifestation of chronic obstructive pulmonary disease (COPD), bronchiectasis, pulmonary cystic fibrosis and other chronic airway inflammatory diseases. N-acetylcysteine (NAC) is a sulfhydryl-containing compound, with mucolytic properties, that has been used for decades as a mucolytic agent in several lung disorders.

Modern Medicine – Issue 1 2023

Initial Treatment for COPD –2022 GOLD Guideline

Chronic obstructive pulmonary disease (COPD) is a common, preventable and treatable disease characterised by persistent respiratory symptoms and limitations to airflow due to abnormalities within the airway and/or alveolar damage. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines classify a patient’s COPD and provide recommendations for first-line treatment.

Modern Medicine – Issue 5 2022

Advanced Respiratory Disease: Managing symptoms in the last years of life

Symptoms in advanced respiratory disease are varied and commonly include breathlessness, fatigue and cough. Symptom control can be complex and difficult to navigate, particularly in the last few years of life as the disease progresses and patients’ needs escalate. Management is best optimised through holistic approaches, with management of individual symptoms alongside treatment of the underlying disease process.

Modern Medicine – Issue 3 2022

Putting the Brakes on Asthma Airway Inflammation in Children

Asthma is the most common chronic disease of childhood and its prevalence has substantially increased worldwide, particularly in pre-school children. Chronic inflammation and smooth muscle dysfunction are consistent features of asthma pathophysiology, responsible for disease progression and airway remodelling. Montelukast, a cysteinyl leukotriene 1 receptor antagonist, is indicated as an alternative treatment in paediatric asthma management and to relieve symptoms of seasonal allergies.

Modern Medicine – Issue 1 2022

As-needed Combined Asthma Treatment Yields Better Symptom Control

The Global Initiative for Asthma (GINA) recommends as-needed inhaled corticosteroid (ICS)-formoterol as an alternative to maintenance ICS plus short-acting β2-agonist (SABA) reliever at step 2 of its stepwise treatment algorithm. As-needed ICS-formoterol may be the preferred option when prevention of severe exacerbation is the primary aim of treatment.

Modern Medicine – Issue 6 2021

SABA Alone no Longer Recommended for Asthma Management

The Global Initiative for Asthma (GINA) critically revises evidence on asthma management yearly and provides a structured set of recommendations. The 2020 GINA Report maintains a major change in the management recommendations, which were introduced in 2019, in relation to pharmacological treatment. GINA no longer recommends treatment of asthma in adults and adolescents with short-acting beta-2 agonists alone.

Modern Medicine – Issue 5 2021

Manifesto on United Airways Diseases (UAD) An Interasma (Global Asthma Association) Document

The large amount of evidence and the renewed interest in upper and lower airways involvement in infectious and inflammatory diseases has led Interasma (Global Asthma Association) to take a position on United Airways Diseases (UAD). Patients with UAD need to have a timely and adequate diagnosis, treatment, and, when recommended, referral for management in a specialised centre. Diagnostic testing including skin prick or serum specific IgE, lung function, fractional exhaled nitric oxide (FeNO), polysomnography, allergen-specific immunotherapies, biological therapies and home based continuous positive airway pressure whenever these are recommended, should be part of the management plan for UAD. This is a shortened version of the original article.

Modern Medicine – Issue 5 2021

Nebulised ICS Targets Respiratory Disease in Kids

Acute asthma attack is a frequent condition in children. It is one of the most common reasons for emergency department visits and hospitalisation. It can be triggered by viral infections, atypical bacteria (ie, Mycoplasma pneumoniae) infections, allergens and/or air pollutants, including tobacco smoke, medications, physical exercise, and stress and emotions. Despite advances in therapy, asthma remains a disease that is not optimally controlled in many children.

Modern Medicine – Issue 2 2021