Four-Year Outcomes from Phase 3 CheckMate -9LA Trial Show ...

severe obstructive airway disease :: Article Creator

What Is Sleep Apnea? Symptoms, Causes And Treatment

There are a number of potential treatments for sleep apnea.

Positive airway pressure (PAP) therapy: Positive airway pressure therapy is the first go-to treatment for sleep apnea, with CPAP (continuous positive airway pressure therapy) being the most effective treatment for obstructive sleep apnea, according to Dr. Won. The treatment utilizes a motorized machine that blows air into a tube that is connected to a mask firmly secured over the face, using mild air pressure to keep your breathing airways open. However, "the challenge is often getting a patient tolerant and compliant to regular CPAP use," she says.

Using an oral appliance: An alternative therapy for obstructive sleep apnea is an oral appliance, "which works to thrust the lower jaw forward to effectively open up the airway space behind the tongue," explains Dr. Won. "This is generally a good option for thinner, younger patients with mild or moderate obstructive sleep apnea related to an anatomical problem." The appliance is a custom device similar to an orthodontic retainer, according to The American Academy of Dental Sleep Medicine. It's typically worn nightly.

Treat the underlying cause: When it comes to central sleep apnea, treatments are different due to different root causes. While CPAP and other types of machines deliver breaths to the patient when the brain doesn't signal a breath might work, the primary treatment method is targeting the underlying cause. For example, if central apnea is related to heart failure, optimizing heart failure treatment may improve central sleep apnea.

Reassess medication: If sleep apnea is medication-induced, it might be necessary to make some adjustments or switch medications. "If central sleep apnea is resulting from opioids, then we try our best to reduce the doses or find alternative pain medications," says Dr. Won.

Lose weight: Being overweight or obese—even moderately—can constrict airways, resulting in sleep apnea. One 2020 study conducted by Penn Medicine and published in American Journal of Respiratory and Critical Care Medicine concludes that it has to do with tongue fat, though the exact mechanism of how tongue size impacts sleep couldn't be established. Reducing tongue fat, via weight loss, was found effective in reducing sleep apnea severity.

Exercise: A large 2020 study in Journal of Clinical Sleep Medicine found that increased physical activity—increasing daily exercise by eight minutes of rigorous daily activity or adding 20 minutes of walking—is associated with a lower risk of obstructive sleep apnea. "Exercising in the morning or early afternoon is best to give you that daytime energy and improve your sleep," Dr. Won adds.

Avoid excessive alcohol consumption: A systematic review of studies published in 2020 in Sleep Medicine concluded that those who consumed higher levels of alcohol—about two drinks or more a week—were more likely to develop sleep apnea.

Advanced, Auto-Adjusting CPAP Technology For Comfortable Sleep

The ResMed AirSense 11 is designed for comfortable, quiet sleep with auto-adjusting pressure levels and built-in, heated humidifier for moisturized air.

Change your sleeping position: Sleeping on your back can cause your tongue and soft palate to position themselves against the back of your throat, blocking your airway. Therefore, experts suggest side or stomach sleeping.

Try nasal decongestants: Nasal obstruction and sleep apnea are linked, research suggests. Decongestants or antihistamines may be helpful in relieving congestion, but you should speak with your physician before using a decongestant on a regular basis.

Surgery: If none of the other treatment methods are effective, there are a few surgery options. The first is a surgery to open up the airway—like a tonsillectomy or jaw advancement surgery—but only for people with "obvious signs of anatomical airway obstruction," says Dr. Won. There is also the option of implanting an upper airway stimulator, which is "like a pacemaker for the tongue" that's implanted in the chest wall. "This stimulates the tongue during sleep so it doesn't collapse onto and obstruct the airway," she says.

What Are The Symptoms Of RSV In Adults?

Respiratory syncytial virus, or RSV, is a respiratory infection that is commonly known for affecting young children, but research in…

Respiratory syncytial virus, or RSV, is a respiratory infection that is commonly known for affecting young children, but research in recent years has shed light on its impact on adults. RSV is not only a concern for older adults, but also for individuals with underlying chronic medical conditions, such as heart or lung disease.

With the potential to cause severe illness, and even death in some cases, recognizing the symptoms, risk factors and preventive measures is crucial to ensuring you and your loved ones stay healthy, especially during cold and flu season in the fall and winter months.

[See: Common Childhood Respiratory Diseases.]

What Is RSV?

RSV is a common, highly contagious viral respiratory infection.

"(The virus) gets back into your throat, your nose, and then importantly, it can get down into your chest and involve your bronchial tubes," says Dr. William Schaffner, medical director of the National Foundation for Infectious Diseases and a professor of infectious diseases at the Vanderbilt University Medical Center in Nashville, Tennessee.

RSV has a reputation for being a serious disease in young children because they have very small bronchial tubes, the airways that let air in and out of your lungs. If they get inflamed, they tend to close off which results in difficulty breathing, Schaffner says.

In fact, RSV is the leading cause of hospitalization of children of ages 1 to 2.

[See: Ways to Boost Your Immune System.]

RSV in Adults

Though RSV is commonly known as a respiratory infection that affects children, researchers have learned a lot over the last 20 years about how it affects adults.

"We have come to learn that (RSV) is another very important winter respiratory virus that particularly affects older adults and people with underlying chronic illnesses, particularly those with heart disease and those with any kind of lung ailments," Schaffner says.

According to the Centers for Disease Control and Prevention, RSV causes approximately 60,000 to 120,000 hospitalizations and 6,000 to 10,000 deaths annually among adults ages 65 and older.

RSV Symptoms in Adults

RSV symptoms in adults and children are very similar.

"You cannot differentiate them from 'a common cold' or 'the flu' without testing," says Dr. Jay Varma, director of the Weill Cornell Center for Pandemic Prevention and Response and Kroll's Chief Medical Advisor/Kroll Institute Fellow.

Common symptoms of RSV in adults and children include:

— Runny nose.

— Stuffy nose.

— Sore throat.

— Cough.

— Fever.

— Fatigue.

— Trouble breathing, in severe cases.

"Babies and young children tend to have more wheezing as a result of RSV infection, a condition known as 'bronchiolitis,'" Varma says.

Risk Factors for RSV in Adults

Several underlying risk factors may make certain adult populations more susceptible to severe symptoms.

"RSV infections can occur in all adults, regardless of whether they have any underlying medical conditions," Varma says. "The main difference is whether or not those infections cause severe illness."

Specific factors and underlying medical conditions that can cause severe illness include:

— People who are older than 65 years old.

— Having a weakened immune system.

— Diabetes.

— Chronic heart disease or heart failure.

— Chronic lung disease, such as chronic obstructive pulmonary disease, or COPD, and asthma.

— Pregnancy.

"The most important long-term complication of RSV infection in adults is that it makes underlying medical conditions far worse," Varma says. "Specifically, if you have diabetes, heart failure or COPD, an RSV infection can make your illness more severe both during the acute phase and after you seem to have recovered."

RSV could also lead to serious conditions like pneumonia, or infection of the lungs.

Testing for RSV

Since they all involve the respiratory tract, influenza, COVID and RSV affect the body in a very similar fashion. Therefore, providers typically can't be certain of which virus is causing the illness without testing.

"The methods to test for RSV are similar to those for COVID," Varma says.

The most commonly used clinical laboratory testing for RSV includes:

— Molecular rRT-PCR tests. The best method is to use a PCR test.

— Rapid antigen tests.

According to the Centers for Disease Control and Prevention, rapid antigen tests are highly sensitive for younger children but not sensitive for older children and adults because they may have lower viral loads in their respiratory specimens.

Both PCR and antigen tests are completed by a health care provider. However, in May 2022, the Food and Drug Administration also authorized the first at-home PCR test where individuals can test for RSV and flu, as well as COVID-19. The Labcorp Seasonal Respiratory Virus RT-PCR DTC Test is available for use without a prescription. Individuals collect a nasal swab sample at home, send it out to Labcorp for testing, and the results of the test become available via an online portal.

How to Treat RSV in Adults

Currently, there are no drugs available to treat RSV infection. Mild cases of RSV typically resolve on their own within one to two weeks.

Treatment of RSV focuses on supportive, symptomatic care, including:

— Hydration.

— Fever and pain management, such as with over-the-counter fever reducers like acetaminophen.

— Oxygen support in severe cases.

People who are older, have underlying illnesses, are immunocompromised or pregnant should have a very low threshold for contacting their health care provider if they develop a respiratory illness, Schaffner emphasizes.

"The most important thing for adults is to try to prevent being infected in the first place," Varma says.

RSV Prevention

In May, the Food and Drug Administration announced approval for the first RSV vaccine for use in the U.S. In adults ages 60 and older. In clinical trials, the vaccine has shown to be very effective at reducing severe illness.

The CDC's Advisory Committee on Immunization Practices are expected to release guidance for who should receive the vaccine in late June.

Additional measures, especially during the winter months, can help prevent RSV and other respiratory illnesses.

"The same approaches that work for COVID can work for RSV," Varma says.

Especially if you fall into a high-risk group, important preventive measures include:

— Using high-quality, well-fitting masks when out in public.

— Spending time outdoors or in well-ventilated areas.

— Improving ventilation — for example, opening windows — when you are indoors.

— Washing your hands thoroughly and often.

— Regularly cleaning and disinfecting surfaces.

Exercise Rehabilitation Found To Help Alleviate Symptoms Of Several Chronic Respiratory Diseases

Researchers discovered that exercise helps to alleviate various symptoms for patients with chronic obstructive pulmonary disease, bronchial asthma, bronchiectasis, interstitial lung disease, and lung cancer.

Training-based pulmonary exercise rehabilitation is effective in alleviating the symptoms of chronic respiratory diseases (CRDs), including chronic obstructive pulmonary disease (COPD), according to a study published in the International Journal of Chronic Obstructive Pulmonary Disease.

Researchers conducted a review examining the positive rehabilitative effects of exercise on COPD, bronchial asthma, bronchiectasis, interstitial lung disease, and lung cancer. Along with alleviating symptoms, they found that exercise improved patients' quality of life, cardiovascular function, tolerance to physical activity, and muscle function.

"Moderate-intensity aerobic exercise, resistance training, and [high-intensity interval training] are the most common forms of pulmonary rehabilitation exercises," the authors wrote.

For those with COPD, the authors hypothesized that exercise would improve their immune response, leading to the activation of their adaptive immune response. They said they came to this conclusion due to similar studies done on mice.

"In animal studies, aerobic exercise was found to prevent the increase in macrophage and neutrophil count in mice with COPD; a similar trend was found in population trials, with a significant reduction in eosinophil count in vivo after 6 weeks of endurance and strength training," the authors wrote.

Additionally, a study in patients with COPD found that a 12-week exercise training regimen was associated with an increase in CD4+ T cells, better immune response, and fewer COPD exacerbations and hospitalizations.

Because of these results, the authors concluded that exercise is an effective strategy for COPD patients to reduce pulmonary and systemic inflammation, alleviate symptoms, and prevent disease progression.

Patients with asthma, who are more prone to fatigue and breathing difficulties during exercise, are often encouraged to reduce or eliminate physical activity to avoid symptom deterioration or exercise-induced bronchoconstriction; this could lead to decreased fitness and exercise tolerance, ultimately leading to exercise avoidance.

The authors instead claimed that patients with asthma are capable of physical activity and could improve their health status with it as aerobic exercise helps them manage airway inflammation.

"…Aerobic exercise has been found to effectively reduce airway eosinophilic expression, which in turn reduces the inflammation, inhaled glucocorticoid (ICS) dosage, and acute exacerbations, under the premise of standardizing and optimizing ICS medication," the authors wrote. "Aerobic training can also positively modulate airway inflammation and remodeling mediators."

Consequently, aerobic training and medication together can help patients with asthma.

Patients with lung cancer can also benefit from exercise. Lung cancer, the leading cause of cancer-related deaths, is broken down into 2 subtypes: non–small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). Pneumonectomy is currently the most effective treatment for stages I, II, and IIIA of NSCLC, offering the best chance for long-term survival.

Exercise can benefit patients both preoperatively and postoperatively, as population-based trials have showed that resistance training improved participants' muscle mass, strength, and sleep quality. Also, for those who previously could not undergo surgery due to poor preoperative evaluations, 4 weeks of aerobic exercise and respiratory training improved both their lung function and chances of undergoing surgery.

"Aerobic exercise improves exercise tolerance and cardiorespiratory fitness and reduces postoperative respiratory morbidity, length of hospital stay, cancer fatigue, anxiety, and depression," the authors wrote.

Because of its positive effects, the authors considered exercise an effective adjunct to existing anticancer therapies.

Patients with bronchiectasis benefit from exercise as resistance training and aerobic exercises of the upper and lower extremities can improve their exercise capacity, endurance, lung function, and peripheral and respiratory muscle strength. It can also reduce dyspnea and raise patients' quality of life.

The authors noted that it is challenging for patients with bronchiectasis to maintain these benefits as it becomes difficult for them to adhere to the regimen as the exercise cycles increase; as they exercise less, the positive cumulative effect decreases accordingly.

Patients with interstitial lung disease (ILD) are affected by dyspnea, exercise-induced hypoxemia, and exercise intolerance. It is difficult for patients to achieve adequate exercise intensity, the researchers wrote, but the standard COPD exercise program of aerobic exercise training appears to be effective.

The authors advised patients with ILD to start exercise training as soon as possible as exercise becomes more difficult in the late stages of symptoms. Exercise reduces patients' lung inflammation and glucocorticoid-induced damage to the immune system.

Overall, additional high-quality randomized controlled trials are required to further evaluate the effect of exercise on patients with CRD.

"More in-depth studies are needed to investigate the pathophysiological mechanisms by which different forms of exercise improve CRD and determine alternatives to pulmonary rehabilitation in patients with exercise limitations," the authors concluded.

Reference

Xiong T, Bai X, Wei X, Wang L, Li F, Shi H, Shi Y. Exercise rehabilitation and chronic respiratory diseases: effects, mechanisms, and therapeutic benefits. Int J Chron Obstruct Pulmon Dis. 2023;18:1251-1266. Doi:10.2147/COPD.S408325

Search This Blog

Poliomyelitis