Current Respiratory Medicine Reviews - Volume 10, Issue 4, 2014

We have coined the term “Malignant Obesity Hypoventilation Syndrome” (MOHS) to describe a severe multisystem disease due to the systemic effects of obesity. Patients with this syndrome have severe obesity related hypoventilation together with systemic hypertension, diabetes and the metabolic syndrome, left ventricular hypertrophy with diastolic dysfunction, pulmonary hypertension and hepatic dysfunction. Patients with MOHS are frequently admitted to the ICU with hypercapnic respiratory failure and have a high mortality. This syndrome is largely unrecognized as physicians do not make the association between the patients’ multiple medical problems and obesity. Due to the delayed diagnosis and progressive morbidities of this condition all patients with a BMI > 40 kg/m2 should be screened for MOHS. The management of patients with MOHS includes short term measures to improve the patients’ medical condition and long term measures to achieve enduring weight loss. Bariatric surgery reverses or improves the multiple metabolic and organ dysfunctions associated with MOHS and should be strongly considered in these patients.

Mesothelioma is an often fatal cancer arising from the lining of pleura, peritoneum, pericardium and tunica vaginalis (of the testis). In the past decade, investigators have met with limited or minimal success in demonstrating improvements in survival compared to supportive care or observation. Radical surgery such as extrapulmonary pleurectomy is associated with perioperative mortality rates of 6-30% by different institutions, compared to 3% with extended pleurectomy and decortication. Talc pleurodesis is preferred over video-assisted thorascopic partial pleurectomy in the setting of pleural effusion due to fewer complications and shorter hospital stay. To spare normal tissues, radiotherapy with IMRT (intensity-modulated radiation therapy) technique should be used in all cases. Reirradiation with proton particles for recurrent disease is being investigated. The ongoing PIT (Prophylactic Irradiation of Tracts) study will explore the effectiveness of radiotherapy to prevent or delay recurrent nodules on the chest wall following invasive chest wall intervention. The literature on this question is varied and inconclusive. Pemetrexed-cisplatin is currently the standard as first line therapy for malignant pleural mesothelioma in accordance with a phase III study showing improved quality of life and survival. In 2012, a new promising biomarker, fibulin-3 was reported in all mesothelioma sites. Fibulin-3 is a superior prognosticator compared with mesothelin and can be used to monitor tumor response. Mesothelin, the cell-surface glycoprotein, has become the primary target for immunotherapy. SS1P is a recombinant antimesothelin immunotoxin which induces a durable response in all mesotheliomas.

Recent studies have shown the relevance of anxiety and depression on the prognosis and outcome of COPD patients, which lead to an increased risk of exacerbations and hospitalisations, a high risk of mortality, greater functional impairment, poorer quality of life, poor adherence to rehabilitation and respiratory care, better use of health resources and increased frequency of COPD symptoms. Their high prevalence is probably due to lack of knowledge, inadequate assessment and undertreatment of psychiatric symptoms and/or disorders. It is, therefore, necessary to assess the presence of anxiety and/or depression in COPD patients in details and subsequent treatment to suitably control their psychiatric disorder as this will result in better control and progression of COPD.

Tuberculosis (TB) is a major cause of illness and death. The worldwide epidemic of HIV/AIDS and emergence of multidrug-resistant and extensively drug-resistant TB, are exacerbating this global public health issue. In this situation, several innovative approaches are being pursued to further improve the existing measures, as well as to identify new one. Recently, stem cell transplantation has emerged as a novel therapeutic option which holds promises for the treatment of many non-infectious and infectious diseases. Recent advances and experimental studies attracted the interest of researchers for exploring the stem cellbased treatment as a candidate treatment option for drug resistant tuberculosis. To date little has been published concerning the short and long term therapeutic effect of any type of stem cells in patients suffering from drug resistant tuberculosis. The purpose of this review is to present the viewpoints on current status and future prospect of this novel treatment approach in severe form of TB and also to discuss the opportunities and challenges associated with this approach.

Patients of Tuberculosis have poor treatment outcome with high mortality. Immunodeficiency appears to be an important risk factor in the development of multi drug resistance (MDR) and extensively drug resistance (XDR) tuberculosis. Mesenchymal stromal cell (MSCs) having immunomodulatory effect, have been used as adjunct autologous treatment. Thereby, it helps in transforming chronic inflammation into productive immune response. Stem cells therapy is based on the principle, that it migrates to the site of injury and forms tissue specific cell type that can replace the damaged tissue. Autologous MSCs have been used as an adjunct treatment in MDR TB in the lungs for accelerating clearance of pathogenic bacteria and early recovery. It appears to be a promising procedure for enhancing the efficacy of anti-TB therapy in MDR and XDR subjects.

Idiopathic pulmonary fibrosis (IPF), or usual interstitial pneumonitis (UIP) is one of the most common causes of pulmonary fibrosis. It is characterized by progressive fibrosis of both lungs. The diagnosis is usually made on the basis of high resolution CT scan of chest or open lung biopsy. Treatment for UIP has been mainly empirical. Besides lung transplant, no clear-cut medical therapy has emerged. In 2010 European union approved pirfenidone. The approval by this drug lagged in USA. On October 15th 2014, Food and Drug Administration (FDA) approved Nintedanib and Pirfenidone for patient use in United States of America. We present a brief commentary on the basic disease process and the new emerging therapies.