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Immunomodulatory effects of macrolides during community-acquired pneumonia: a literature review.

Macrolides are known to possess immunomodulatory properties, next to their antimicrobial effects. These immunomodulatory activities have been proven beneficial in chronic pulmonary inflammatory diseases. Whether macrolides also exert favourable immunomodulatory effects during acute inflammation, and therefore can act as adjuvant therapy in community-acquired pneumonia (CAP), is less clear.

We aimed to give an overview of the existing evidence from in vitro and in vivo studies on the immunomodulatory effects of macrolides during CAP. A comprehensive search in the PubMed/MEDLINE and Embase databases was performed. Two investigators independently examined the eligible literature.

Studies that dealt with the effects of macrolides on the immune response, in terms of cytokine secretion and the number or function of inflammatory and structural cells during acute inflammation, were included. A total of 27 studies were included, of which 15 were in vitro studies, 9 in vivo, 2 both in vivo and in vitro, and 1 was in human subjects. Although the methods and experimental model systems used in these studies are very heterogeneous, macrolides in general tempered inflammation caused by viable and non-viable bacteria or their products. Cytokine secretion decreased, as did inflammatory and structural cell activation and histological inflammatory signs. Not all data, however, are consistent and sometimes pro-inflammatory effects were found.

To conclude, the available literature suggests that macrolides can temper the inflammatory response during CAP, independent of their antimicrobial activity. However, because the studies differ in their methodology, no definite conclusions can be drawn.

Early cardiac arrest in patients hospitalized with pneumonia: a report from the American Heart Association's Get With the Guidelines - Resuscitation Program.

Pneumonia is the leading infectious cause of death. Early deterioration and death commonly result from progressive sepsis, shock, respiratory failure, and cardiac complications. Recent data suggest that cardiac arrest may also be common, yet few previous studies have addressed this. Accordingly, we sought to characterize early cardiac arrest in hospitalized patients with co-existing pneumonia.

METHODS:We performed a retrospective analysis of a multicenter cardiac arrest database, with data from more than 500 North American Hospitals. We included in-hospital cardiac arrest events that occurred in community-dwelling adults with pneumonia within the first 72 hours after hospital admission. We compared patient and event characteristics for patients with and without pneumonia. For patients with pneumonia we also compared events according to event location.

RESULTS:We identified 4,453 episodes of early cardiac arrest in patients hospitalized with pneumonia. Among patients with preexisting pneumonia, only 36.5% were receiving mechanical ventilation, and only 33.3% were receiving infusions of vasoactive drugs prior to cardiac arrest. Only 52.3% patients on the ward were receiving electrocardiographic monitoring prior to cardiac arrest. Shockable rhythms were uncommon in all pneumonia patients (ventricular tachycardia or fibrillation, 14.8%). Ward patients were significantly older than patients in the ICU.

CONCLUSIONS:In patients with pre-existing pneumonia, cardiac arrest may occur in the absence of preceding shock or respiratory failure. Clinicians should be alert to the possibility of abrupt cardiopulmonary collapse, and future studies should address this possibility. The mechanism may involve myocardial ischemia, a maladaptive response to hypoxia, sepsis-related cardiomyopathy, or other phenomena.

Rapid effects of extrafine beclomethasone dipropionate/formoterol fixed combination inhaler on airway inflammation and bronchoconstriction in asthma: a randomised controlled trial

Background: The dose-dependent anti-inflammatory effects of a recent fixed combination of extrafine beclomethasone dipropionate/formoterol (BDP/F) were investigated using non-invasive markers of inflammation, exhaled nitric oxide (NO) and adenosine monophosphate (AMP) provocative challenge. The aim was to assess the onset of the anti-inflammatory action of low and high doses and evaluate the suitability of non-invasive assessments to demonstrate dose response. Methods: Steroid naive adult out-patients with mild asthma, sensitive to AMP with baseline exhaled NO >25 parts per billion (ppb) entered a double-blind, placebo-controlled, 3-way, cross-over study. Patients were randomised to low dose (1 actuation) or high dose (4 actuations) extrafine BDP/F 100/6 ug, or placebo administered twice d...

Fluticasone furoate: once-daily evening treatment versus twice-daily treatment in moderate asthma

Conclusions: FF 200 ug OD in the evening is an efficacious and well tolerated treatment for asthma patients and is not inferior to the same total BD dose.Trial registration: Clinicaltrials.gov; NCT00766090. (Source: Respiratory Research)

Cough Hypersensitivity Syndrome Is an Important Clinical Concept: A Pro/Con Debate

Abstract  The major etiologies of chronic cough are generally accepted to consist of upper airway cough syndrome (formerly postnasal drip syndrome), eosinophilic airway inflammation (asthma, nonasthmatic eosinophilic bronchitis), and gastroesophageal reflux disease (GERD). However, only a small percentage of patients with these very common conditions suffers from chronic cough. Furthermore, acute cough due to viral upper respiratory tract infection (URI) is almost always a transient, self-limited condition, yet in a small subgroup of patients, URI heralds the onset of chronic, refractory cough. The cough hypersensitivity syndrome has been proposed to explain the occurrence of chronic cough in a subgroup of patients exposed to the same putative triggers as the vast majority ...

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