Nihon Rinsho. Japanese Journal Of Clinical Medicine[JOURNAL]
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200 papers
[New drugs for asthma; current status and future perspectives].
Gon Y, Maruoka S, Hashimoto S
Nihon Rinsho · 2016 Oct · PMID 30551285
In most asthmatic patients, asthma symptoms can be well controlled through the pharmaco- logical interventions using combination with inhaled corticosteroids(ICSs) and/long-acting beta2-agonists(LABA) inhalers. However,...
In most asthmatic patients, asthma symptoms can be well controlled through the pharmaco- logical interventions using combination with inhaled corticosteroids(ICSs) and/long-acting beta2-agonists(LABA) inhalers. However, there are some severe cases who did not respond to the current asthma therapy. One of topic of development for new asthma drugs is molecular targeting therapy such as anti-Th2-cytokine antibody and chemoattractant recep- tor-homologous molecule expressed on Th2 cells (CRTH2) inhibitors. Other topics are new type of combination inhalers with ICS, LABA, and long-acting muscarinic antagonists (LAMA) inhalers, and development of generic inhalers. In this review, we discussed the current trend of drug development for the asthma treatment.
[The therapy of biological agents in severe asthma].
Tagaya E, Tamaoki J
Nihon Rinsho · 2016 Oct · PMID 30551284
Bronchial asthma is a heterogeneous disease characterized by airway hyperresponsiveness, smooth muscle contraction and airway inflammation. Multiple factors such as genetic back- ground and environmental factors are invo...
Bronchial asthma is a heterogeneous disease characterized by airway hyperresponsiveness, smooth muscle contraction and airway inflammation. Multiple factors such as genetic back- ground and environmental factors are involved in the pathogenesis of asthma. Allergic asthma is a Th2-driven eosinophilic inflammatory disease, in which may cytokines including IL- 4, IL-5, and IL-13 play important roles. Monoclonal antibody therapies target specific mole- cules in severe asthma. Omalizumab, an IgE antibody, reduces symptoms and acute exac- erbations in severe asthma, and mepolizumab, a more recent monoclonal antibody against IL-5, is also efficacious in similar group of patients. In order to improve clinical ability and to achieve optimal health and economical benefit of biologics, further studies on clinical fac- tors and biomarkers which predict the drug efficacy are required.
[Perioperative management for patients with bronchial asthma].
Wada H, Yoshino I
Nihon Rinsho · 2016 Oct · PMID 30551283
To minimize the risks of perioperative respiratory complications in patients with asthma undergoing general anesthesia, the key is detailed preoperative assessment of asthmatic patients. A patient with a history of frequ...
To minimize the risks of perioperative respiratory complications in patients with asthma undergoing general anesthesia, the key is detailed preoperative assessment of asthmatic patients. A patient with a history of frequent exacerbations, aspirin-exacerbated respiratory disease, or recent airway infection has a severe risk of perioperative exacerbation. Pre- operative intervention with anti-inflammatory and bronchodilatory medication should be considered if asthma is poorly controlled before surgery. Another key is adequate anesthetic plan suppressing or avoiding bronchial constriction, including proper selection of anesthetic and appropriate depth of anesthesia at any time point during surgery. Intraoperative bron- chospasm must be managed promptly using bronchodilators and/or steroid. Thorough perioperative management can lead to an uneventful course in patients with asthma.
[Cough variant asthma].
Niimi A
Nihon Rinsho · 2016 Oct · PMID 30551282
Cough variant asthma (CVA), a phenotype of asthma solely presenting with coughing, is the most common cause of chronic cough in Japan, which lasts for 8 weeks or longer. It shares some clinical and pathophysiological fea...
Cough variant asthma (CVA), a phenotype of asthma solely presenting with coughing, is the most common cause of chronic cough in Japan, which lasts for 8 weeks or longer. It shares some clinical and pathophysiological features with classic asthma with wheezing such as seasonal or nocturnal coughing, airway hyperresponsiveness, eosinophilic airway inflammation and airway remodeling. The key diagnostic feature of CVA is the responsiveness of coughing to bronchodilators (beta-agonists), but the mainstay treatment after the established diagnosis is the long-term treatment with inhaled corticosteroids with or without other controller antiasthma medica- tions. Progression of CVA to classic asthma could be prevented with an early introduction of inhaled corticosteroids. Treatment of concomitant gastroesophageal reflux disease, which/ often coexists with CVA, may be considered in intractable cases.
[Exercise-induced bronchoconstriction (EIB)].
Yoshikawa T
Nihon Rinsho · 2016 Oct · PMID 30551281
Exercise-induced bronchoconstriction(EIB) is defined as a transient airway obstruction that follows a modest period of high intensity exercise. Accumulating evidence demonstrated that EIB is reported not only among patie...
Exercise-induced bronchoconstriction(EIB) is defined as a transient airway obstruction that follows a modest period of high intensity exercise. Accumulating evidence demonstrated that EIB is reported not only among patients with asthma (EIBA), but also observed in a signifi- cant number of individuals without a known diagnosis of asthma (EIBWA). Accordingly, most recent guidelines have been largely revised. Since EIBA have different pathological back- ground from that in EIBwA, EIBA and EIBwa might have distinct responses to treatment and prevention despite using similar therapeutic strategies. This article aims to present a brief review on the current understandings of clinical features, pathogenesis, and management of both types of EIB.
[Advances in aspirin-exacerbated respiratory disease (AERD)].
Higashi N, Mitsui C, Taniguchi M
Nihon Rinsho · 2016 Oct · PMID 30551280
Aspirin-exacerbated respiratory disease (AERD) is characterized by the triad of asthma, eosinophilic nasal polyposis and a hypersensitivity to all medications that inhibit the cyclo- oxygenase (COX) -1 enzyme. Clinical h...
Aspirin-exacerbated respiratory disease (AERD) is characterized by the triad of asthma, eosinophilic nasal polyposis and a hypersensitivity to all medications that inhibit the cyclo- oxygenase (COX) -1 enzyme. Clinical history and observed aspirin provocation test remains gold standard for diagnosis of AERD. AERD patients typically have more severe asthma with airflow limitation and greater requirement for high-dose corticosteroid therapies. Over- production of cysteinyl-leukotrienes (CysLTs) and prostaglandin D2 (PGD2) correlate with the pathogenetic features of AERD, suggesting the possible involvement of mast cell activation with innate type 2 immune response. Next breakthroughs in diagnosis and treatment have been expected in the nearest futures.
[Asthma in the elderly].
Matsuse H
Nihon Rinsho · 2016 Oct · PMID 30551279
Since the induction of inhaled corticosteroids as a first line therapy for asthma, severe intrac- table asthma had been decreased. Nonetheless, a proportion of severe asthma still remains including asthma in the elderly....
Since the induction of inhaled corticosteroids as a first line therapy for asthma, severe intrac- table asthma had been decreased. Nonetheless, a proportion of severe asthma still remains including asthma in the elderly. To date, the reasons of severity in elderly asthma are con- sidered due to decline of pulmonary function and low adherence to the therapy, both of which are associated with aging. Airway inflammation is also different between younger and elderly asthma. Neutrophilic inflammation is predominant in the elderly asthma possibly due to imnu- nosenescence and asymptomatic aspiration. Inhaled corticosteroids possess a first line therapy for elderly asthma, while additional treatments for neutrophilic inflammation should be consid- ered including long acting bronchodilator and macrolide antibiotics. Similarly non pharma- cological assessment such as vaccine and smoking cessation are also important for elderly asthma.
[Severe intractable asthma].
Ohta K
Nihon Rinsho · 2016 Oct · PMID 30551278
Severe persistent asthma has been defined as being symptomatic every day with distur- bance of daily life. To judge asthma as severe and intractable, besides misdiagnosis, treatment step 4 has been properly done with goo...
Severe persistent asthma has been defined as being symptomatic every day with distur- bance of daily life. To judge asthma as severe and intractable, besides misdiagnosis, treatment step 4 has been properly done with good adherence, appropriate management of comorbidi- ties, avoidance of risk factors. Management for severe intractable asthma consists of thera- peutic step 4 with adjustment of the dose of sustained release theophylline by a step-wise manner with therapeutic dose monitoring, and selection of ICS or ICS/LABA considering individual state, and selecting intermittent administration of OCS and/or anti-IgE(omali- zumab) or anti-IL-5 (mepolizumab) antibodies after getting informed consent from a patient.
[Treatment for acute exacerbation of bronchial asthma].
Nakagome K, Nagata M
Nihon Rinsho · 2016 Oct · PMID 30551277
Diagnosis of asthma exacerbations (e.g. exclusion of acute heart failure) and assessment of its severity are important for treatment of asthma attacks. Both airway constriction and inflammation are therapeutic targets fo...
Diagnosis of asthma exacerbations (e.g. exclusion of acute heart failure) and assessment of its severity are important for treatment of asthma attacks. Both airway constriction and inflammation are therapeutic targets for asthma exacerbations. Inhaled 02-agonists, corti- costeroids, aminophylline, adrenaline, oxygen therapy, and others are used as needed in acute exacerbations by choosing treatment steps for asthma exacerbations depending on the severity of attacks.
[Outline of pharmacotherapy of adult bronchial asthma based on Japanese asthma guideline 2015].
Horie T
Nihon Rinsho · 2016 Oct · PMID 30551276
Recent Japanese asthma guideline was published in 2015 (JGL2015). Variability of asthma symptom and airflow limitation was added to its definition. Updated information of pharma- cotherapy in adult asthma was documented....
Recent Japanese asthma guideline was published in 2015 (JGL2015). Variability of asthma symptom and airflow limitation was added to its definition. Updated information of pharma- cotherapy in adult asthma was documented. Long-acting anticholinergics as add-on therapy to inhaled corticosteroids combined with a LABA were incorporated into the step 3 and 4 in adult patients. Clinician should confirm treatment adherence and correct inhaler technique, and take enough time to discuss about treatment at every visit.
[Differential diagnosis].
Nakamura Y
Nihon Rinsho · 2016 Oct · PMID 30551275
The points for differential diagnosis of asthma attack and other diseases are as follows. Acute heart failure (image analysis, BNP), hyperventilation syndrome (limbs numbness, low PaCO2), vocal cord dysfunction (stridor...
The points for differential diagnosis of asthma attack and other diseases are as follows. Acute heart failure (image analysis, BNP), hyperventilation syndrome (limbs numbness, low PaCO2), vocal cord dysfunction (stridor in the neck, normal SpO2), COPD exacerbation (smoking history, image analysis), pulmonary thromboembolism (contrasting CT, elevated D-dimer), spontaneous pneumothorax (chest pain, image analysis), large airway disease (inspi- ratory stridor, image analysis). Examinations for diagnosis of bronchial asthma in stable phase are respiratory function tests, increased eosinophils in sputum, FeNO, serum periostin and allergological examination (specific IgE, skin test). For differential diagnosis of stabled asthma and other diseases, important points are as follows. COPD(HRCT, DLco), ACOS(HRCT, DLco, increased eosinophils in sputum), chronic heart failure (BNP, ecohcardiogram), large airway disease(image analysis, flow-volume curves).
[Pulmonary function testing in bronchial asthma].
Tabata M, Kurosawa H
Nihon Rinsho · 2016 Oct · PMID 30551274
The lung function of asthma is characterized by the following points: - Airflow limitation that reverses after administration of a bronchodilator - Variable airflow limitation Airway hyperresponsiveness, that is, an exce...
The lung function of asthma is characterized by the following points: - Airflow limitation that reverses after administration of a bronchodilator - Variable airflow limitation Airway hyperresponsiveness, that is, an excessive decrease in airflow in response to an aerosolized provocation that elicits little or no response in a normal person. Airflow limitation from asthma usually demonstrates some degree of reversibility following acute inhalation with a beta-agonist. But patients with mild asthma often do not show this reversibility. Patients can measure peak expiratory flow(PEF) by themselves using a simple device. We can assess the patient's condition by monitoring their PEF. The circadian variation of PEF usually indicates the existence of airway hyperresponsiveness. Airway hyperresponsive- ness is directly measured by bronchoprovocation testing using direct inhalation of meth- acholine or histamine. Indications for bronchoprovocation testing include the accurate diag- nosis of asthma in selected patients, such as patients who do not show airway reversibility, assessment of severity of asthma and assessment of the response to asthma therapy.
[Radiologic finding of bronchial asthma].
Nishimoto Y, Noma S, Taguchi Y
Nihon Rinsho · 2016 Oct · PMID 30551273
High-resolution computed tomography (HRCT) scan is a noninvasive technique that might be valuable for evaluating bronchial wall thickening and bronchiectasis as a result of chronic inflammation in patients with severe as...
High-resolution computed tomography (HRCT) scan is a noninvasive technique that might be valuable for evaluating bronchial wall thickening and bronchiectasis as a result of chronic inflammation in patients with severe asthma. HRCT is also useful to diagnose the complications of asthma such as pulmonary emphysema and chronic eosinophilic pneumonia. In addition, HRCT will be able to demonstrate the tracheobronchial and parenchymal abnormality dis- tinctly, with the result that it will be helpful for making differential diagnosis in the patients with wheeze, including allergic bronchopulmonary aspergillosis, eosinophilic granulomatosis with polyangiitis, bronchial tuberculosis and tracheal tumor.
[Interviewing of patients, physical findings, laboratory findings].
Komase Y
Nihon Rinsho · 2016 Oct · PMID 30551272
When diagnosing bronchial asthma, it is necessary to make a comprehensive assessment of the information obtained by interviewing the patient, physical findings, and laboratory findings, while taking into consideration th...
When diagnosing bronchial asthma, it is necessary to make a comprehensive assessment of the information obtained by interviewing the patient, physical findings, and laboratory findings, while taking into consideration the course of the condition. This is not an easy task unless it is a classic case. On the other hand, based on the information obtained from the patient interview, it is possible to make predictions to some extent and conduct laboratory tests accordingly. During the patient interview, considerations should be given to other possible diseases, concomitant diseases, degree of severity with/without attacks.
[Genetic and environmental factors associated with bronchial asthma].
Tanimoto Y, Tanimoto M
Nihon Rinsho · 2016 Oct · PMID 30551271
Many genetic and environmental factors associated with bronchial asthma have been investigated. These include disease-related genome, obesity, smoking, and rhinitis. Several susceptibility loci for bronchial asthma were...
Many genetic and environmental factors associated with bronchial asthma have been investigated. These include disease-related genome, obesity, smoking, and rhinitis. Several susceptibility loci for bronchial asthma were recently identified by genome-wide association study(GWAS). GWAS requires future functional analysis. Obesity, smoking, and rhinitis are each risk factor for development of asthma. Moreover, obesity as well as smoking is asso- ciated with severe or uncontrolled asthma.
[Adult bronchial asthma, definition, cause and severity assessment].
Narumoto O
Nihon Rinsho · 2016 Oct · PMID 30551270
Bronchial asthma is a serious global burden affecting 1 to 18 % of people in different countries and the number is increasing. Asthma is characterized by chronic airway inflam- mation, which leads to symptoms of wheeze,...
Bronchial asthma is a serious global burden affecting 1 to 18 % of people in different countries and the number is increasing. Asthma is characterized by chronic airway inflam- mation, which leads to symptoms of wheeze, shortness of breath, chest tightness due to airflow limitation. Symptoms and degree of airflow limitation change over time, however usually persist. Asthma is also associated with airway hyper responsiveness to stimuli leading to repeated cough which deteriorate quality of life of asthma patients. Here I describe the definition of asthma, its cause, and assessment of severity in line with the Asthma Prevention and Management Guideline 2015, Japan.
[Asthma prevention and management guidelines 2015, Japan: comparison with GINA2015].
Ichinose M
Nihon Rinsho · 2016 Oct · PMID 30551269
Asthma prevention and management guidelines (JGL) 2015 were published by the Japanese Society of Allergology. In the JGL2015, asthma is characterized by chronic airway inflam- mation and symptoms, such as wheeze and coug...
Asthma prevention and management guidelines (JGL) 2015 were published by the Japanese Society of Allergology. In the JGL2015, asthma is characterized by chronic airway inflam- mation and symptoms, such as wheeze and cough, that vary over time as also described in Global Initiative for Asthma (GINA) 2015. Concerning the pharmacotherapy for asthma, medications are divided into 2:types, such as controller agents used continuously for long-term management (controllers) and reliever agents used for a short period to treat asthma symptoms(relievers) in both the JGL2015 and GINA2015. Asthma treatment is divided into 4 treatment steps based on the asthma sever- ity in the JGL2015, and into 5 steps in the GINA2015.
[Epidemiology of asthma in Japan].
Iwanaga T, Tohda Y
Nihon Rinsho · 2016 Oct · PMID 30551268
In Japan, asthma prevalence is 8-14 % in children aged 0-14 years in 2008, 9-10 % in adults aged 15 and over in 2006-2007. Asthma prevalence does not change more than the past 10 years or tends to fall in children, but i...
In Japan, asthma prevalence is 8-14 % in children aged 0-14 years in 2008, 9-10 % in adults aged 15 and over in 2006-2007. Asthma prevalence does not change more than the past 10 years or tends to fall in children, but is increasing in adults. The number of patients with asthma was 1,177,000 in 2014; however, it is thought there are a lot more patients who are not visiting medical facilities. The number of inpatients with asthma decreased from 19,100 patients in 1999 to 5,300 patients in 2014. Asthma mortality also decreased from 6,370 patients in 1980 to 1,550 patients in 2014 dramatically. It's a clinical problem that the per- centage of the elderly patients in asthma death occupies about 90 %.
[Melanoma cell adhesion molecule (MCAM)/CD146 is a novel marker for malignant glioma].
Yawata T, Ueba T
Nihon Rinsho · 2016 Sep · PMID 30652830
Abstract loading — click title to view on PubMed.
[Oncolytic virus therapy].
Tanaka M, Todo T
Nihon Rinsho · 2016 Sep · PMID 30634850
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