| 1. |
- Andersson, Cecilia, et al.
(författare)
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Revisiting the role of the mast cell in asthma.
- 2016
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Ingår i: Current Opinion in Pulmonary Medicine. - 1531-6971. ; 22:1, s. 10-17
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Forskningsöversikt (refereegranskat)abstract
- In humans, mast cells are ubiquitously present in tissues adjacent to external environment and consequently have an important sentential role in host defence, homeostasis and repair. Their key role in allergen-mediated conditions has been recognized for many decades already. So far, therapies targeting mast cells offered clinical efficacy in allergic conditions except for asthma. More recently, sophisticated sampling and detection techniques revealed pleiotrophic immunological and functional properties of mast cells in and beyond asthma with potential clinical and management implications. These findings bring back the mast cell as a key player in the field of asthma and warrant a review of the recent literature.
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| 2. |
- Andersson Sjöland, Annika, et al.
(författare)
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Fibrocytes and the tissue niche in lung repair
- 2011
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Ingår i: Respiratory Research. - : Springer Science and Business Media LLC. - 1465-9921 .- 1465-993X. ; 12
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Forskningsöversikt (refereegranskat)abstract
- Human fibrocytes are bone marrow-derived mesenchymal progenitor cells that express a variety of markers related to leukocytes, hematopoietic stem cells and a diverse set of fibroblast phenotypes. Fibrocytes can be recruited from the circulation to the tissue where they further can differentiate and proliferate into various mesenchymal cell types depending on the tissue niche. This local tissue niche is important because it modulates the fibrocytes and coordinates their role in tissue behaviour and repair. However, plasticity of a niche may be co-opted in chronic airway diseases such as asthma, idiopathic pulmonary fibrosis and obliterative bronchiolitis. This review will therefore focus on a possible role of fibrocytes in pathological tissue repair processes in those diseases.
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| 3. |
- Andersson Sjöland, Annika, et al.
(författare)
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Versican in inflammation and tissue remodelling: the impact on lung disorders.
- 2015
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Ingår i: Glycobiology. - : Oxford University Press (OUP). - 1460-2423 .- 0959-6658. ; 25:3, s. 243-251
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Forskningsöversikt (refereegranskat)abstract
- Versican is a proteoglycan that has many different roles in tissue homeostasis and inflammation. The biochemical structure is comprised of four different types of the core protein with attached glycosaminoglycans that can be sulphated to various extents and has the capacity to regulate differentiation of different cell types, migration, cell adhesion, proliferation, tissue stabilization and inflammation. Versican's regulatory properties are of importance during both homeostasis and changes that lead to disease progression. The glycosaminoglycans that are attached to the core protein are of the chondroitin sulfate/dermatan sulfate type and are known to be important in inflammation through interactions with cytokines and growth factors. For a more complex understanding of versican it is of importance to study the tissue niche, where the wound healing process in both healthy and diseased conditions take place. In previous studies our group has identified changes in the amount of the multifaceted versican in chronic lung disorders such as asthma, chronic obstructive pulmonary disease and bronchiolitis obliterans syndrome, which could be a result of pathologic, transforming growth factor β driven, on-going remodelling processes. Reversely, the context of versican in its niche is of great importance since versican has been reported to have a beneficial role in other contexts e.g. emphysema. Here we explore the vast mechanisms of versican in healthy lung and in lung disorders.
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| 4. |
- Bjermer, Leif
(författare)
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Astma är en systemisk inflammation--inte en lokal sjukdom Bred antiinflammatorisk behandlingsstrategi krävs.
- 2009
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Ingår i: Läkartidningen. - 0023-7205. ; 106:30-31, s. 1905-1908
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Forskningsöversikt (refereegranskat)abstract
- The traditional view of asthma has changed considerably during the last decades. A paradigm shift in our understanding of asthma has turned our focus from the importance of muscle spasm to inflammation. Today asthma is believed to be a central airway inflammatory disorder, and the importance of activated eosinophils found in central airway biopsies and in induced sputum is believed to be a hallmark of this inflammatory process. Anti-inflammatory treatment in asthma has for long been seen as treatment with cortisone. Moreover, the view of asthma as mainly a central airway disorder, make it logic to treat this what is believed to be a central airway disorder, locally by the inhaled route. During the recent year we have gained a lot of new knowledge challenging the current view of asthma. While previous asthma treatment guidelines mainly have focused on asthma as a organ disorder, more modern guidelines such as ARIA (Allergic Rhinitis and its Impact on Asthma) have revealed the necessity of treating not only the lower but also the upper airways. It is also clear that corticosteroid therapy do not suppress all parts of the asthmatic inflammation and other, more or less “steroid refractory mechanisms” ask for complementary strategies in order to achieve a better control of the asthmatic inflammation. Finally, not only the upper airways seem to be commonly involved in asthma patients. The peripheral “small airways” and the lung parenchyma, as well as organs outside the thorax, contribute to the inflammatory burden of the disease. Thus in order to be able to advance further in our management strategies we need to change our view of asthma from an organ centred to a more systemic approach. It is really time for a paradigm shift!
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| 5. |
- Bjermer, Leif, et al.
(författare)
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Current evidence and future research needs for FeNO measurement in respiratory diseases
- 2014
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Ingår i: Respiratory Medicine. - : Elsevier BV. - 0954-6111 .- 1532-3064. ; 108:6, s. 830-841
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Forskningsöversikt (refereegranskat)abstract
- Although not yet widely implemented, fraction of exhaled nitric oxide (FeNO) has emerged in recent years as a potentially useful biomarker for the assessment of airway inflammation both in undiagnosed patients with non-specific respiratory symptoms and in those with established airway disease. Research to date essentially suggests that FeNO measurement facilitates the identification of patients exhibiting T-helper cell type 2 (Th2)-mediated airway inflammation, and effectively those in whom anti-inflammatory therapy, particularly inhaled corticosteroids (ICS), is beneficial. In some studies, FeNO-guided management of patients with established airway disease is associated with lower exacerbation rates, improvements in adherence to anti-inflammatory therapy, and the ability to predict risk of future exacerbations or decline in lung function. Despite these data, concerns regarding the applicability and utility of FeNO in clinical practice still remain. This article reviews the current evidence, both supportive and critical of FeNO measurement, in the diagnosis and management of asthma and other inflammatory airway diseases. It additionally provides suggestions regarding the practical application of FeNO measurement: how it could be integrated into routine clinical practice, how its utility could be assessed and its true value to both clinicians and patients could be established. Although some unanswered questions remain, current evidence suggests that FeNO is potentially a valuable tool for improving the personalised management of inflammatory airway diseases.
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| 6. |
- Bjermer, Leif
(författare)
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Evaluating combination therapies for asthma: pros, cons and comparative benefits
- 2008
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Ingår i: Therapeutic Advances in Respiratory Disease. - : SAGE Publications. - 1753-4666. ; 2:3, s. 149-161
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Forskningsöversikt (refereegranskat)abstract
- Combination therapies with inhaled corticosteroids (ICS) and either long-acting ß2 agonists (LABA) or leukotriene receptor antagonists (LTRA) are commonly used to help patients maintain control of their asthma. LABA and LTRA have different mechanisms of action and both provide complementary benefits when combined with ICS. This paper compares the two regimens based on recent clinical trial data, evaluates their efficacy on various clinical and quality of life outcomes, and discusses the importance of therapy choice in people with specific asthma phenotypes. The potential of new dosing strategies, including adjustable maintenance therapy and single-inhaler maintenance and reliever therapy is also reviewed. Given the variety of outcomes, phenotypes, and treatment strategies that must be considered, the importance of individualized management is emphasized.
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| 7. |
- Bjermer, Leif, et al.
(författare)
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Long-acting beta(2)-agonists: how are they used in an optimal way?
- 1997
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Ingår i: Respiratory Medicine. - 1532-3064. ; 91:10, s. 587-591
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Forskningsöversikt (refereegranskat)abstract
- Inhaled long-acting beta(2)-agonists are frequently used for the treatment of asthma. When introduced to the market, the drug was accompanied by a debate among physicians and scientists raising warnings against the use of beta(2)-agonists, leading to a risk of tachyphylaxis and worsening of asthma control. During recent years, much of these warnings have been counter proved and there has been a tendency to institute treatment with long-acting beta(2)-agonists somewhat earlier in the course than before. However, the exact place for long-acting beta(2)-agonists in the asthma treatment plans, still needs to be established. While beta(2)-agonists have been shown to have anti-inflammatory activity in vitro and after single allergen exposure, this effect seems to disappear with regular treatment. The same phenomena have been shown to protect against obstruction caused by metacholine inhalation or exercise. Although the protective effect diminishes or even disappears, no signs of rebound phenomena or increased susceptibility to provocative stimulus has been shown. Thus, in contrast to earlier reports after regular use of short-acting beta(2)-agonists, no signs of tachyphylaxis have been reported after use of long-acting beta(2)-agonists. Moreover, the bronchodilatatory effect seems to be fairly stable after regular treatment, even though some reports claims that this effect diminishes over time. The present article is a review of some data involved in this debate. The authors conclude that long-acting beta(2)-agonists are a valuable contribution to the asthma treatment repertoire. However, the drugs should be regarded as long-acting bronchodilatators, supplementing the use of inhaled corticosteroids. The rapid appearing tolerance towards allergen-induced and provoked bronchial obstruction prevents these drugs from being used as monotherapy; they should be used only in combination with sufficient anti-inflammatory treatment, i.e. inhaled corticosteroids.
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| 8. |
- Bjermer, Leif
(författare)
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Targeting small airways, a step further in asthma management
- 2011
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Ingår i: Clinical Respiratory Journal. - 1752-6981. ; 5:3, s. 131-135
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Forskningsöversikt (refereegranskat)abstract
- Introduction: During the last decade, small airway (SA) involvement in asthma and Chronic Obstructive Pulmonary Disease (COPD) have reached increasing attention. Originally referred to as the 'silent zone', SA may not be that silent after all. Important clinical correlates are asthma exacerbations and airways remodelling, exercise asthma and nocturnal asthma. Thus, to control pathology in the SA has become a desirable goal in asthma management. Objectives: The scope of this review is to give a brief overview of the current status on SA in asthma, how to monitor and to diagnose SA inflammation and finally highlight some important treatment strategies. Results/Conclusion: New tools have been developed to monitor SA function; these implies the use of imaging techniques and respiratory physiology, targeting SA function. Fractional exhaled nitric oxide and the combined use of hyperresponsiveness testing with impulsoscillometry is another option. The introduction of ultrafine aerosols has provided new tools for to treat SA inflammation. The challenge for the future will be to define the optimal particle size and device for maximal deposition in entire lung, including the small airways. Moreover, we also need strategies for increasing the therapeutic ratio, i.e. increasing lung deposition without increasing systemic side effects. Another challenge is to design and to perform clinical trials, targeting effects in SA, proving the clinical importance of SA treatment in a large number of patients. The latter also imply education of our medical authorities, communicating that asthma is more than a beta-2 agonist responsive central airway disorder of the lungs.
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| 9. |
- Bjermer, Leif, et al.
(författare)
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The complex pathophysiology of allergic rhinitis : Scientific rationale for the development of an alternative treatment option
- 2019
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Ingår i: Allergy, Asthma and Clinical Immunology. - : Springer Science and Business Media LLC. - 1710-1492. ; 15, s. 24-
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Forskningsöversikt (refereegranskat)abstract
- Allergic rhinitis (AR) poses a global health problem and can be challenging to treat. Many of the current symptomatic treatments for AR have been available for decades, yet there has been little improvement in patient quality of life or symptom burden over the years. In this review, we ask why this might be and explore the pathophysiological gaps that exist within the various AR treatment classes. We focus on the benefits and drawbacks of different treatment options and delivery routes for AR treatments and consider how, given what is known about AR pathophysiology and symptomatology, patients may be offered more effective treatment options for rapid, effective, and sustained AR control. In particular, we consider how a new AR preparation, MP-AzeFlu (Dymista ® , Meda, Sweden), comprising a formulation of an intranasal antihistamine (azelastine hydrochloride), an intranasal corticosteroid (fluticasone propionate), and excipients delivered in a single spray, may offer benefits over and above single and multiple AR therapy options. We review the evidence in support of this treatment across the spectrum of AR disease. The concept of AR control is also reviewed within the context of new European Union and Contre les Maladies Chroniques pour un VIeillissement Actif-Allergic Rhinitis and its Impact on Asthma initiatives.
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| 10. |
- Bjermer, Leif
(författare)
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The Importance of Continuity in Inhaler Device Choice for Asthma and Chronic Obstructive Pulmonary Disease.
- 2014
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Ingår i: Respiration. - : S. Karger AG. - 1423-0356 .- 0025-7931. ; 88:4, s. 346-352
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Forskningsöversikt (refereegranskat)abstract
- Inhaled therapies are central to the treatment of asthma and chronic obstructive pulmonary disease. Physicians consider many factors when selecting the most appropriate inhaler device, including device efficacy and the cost to the health care system. This review aims to discuss the factors that are important when considering inhaler devices and the importance of continuity in the choice of inhaler device. A large number of factors can contribute to therapeutic outcomes with inhalation devices. The inhalation technique is critical to treatment success and differs substantially between inhaler devices. Misuse of an inhaler is common, and thorough training of patients and physicians is important to ensure correct utilization. Patient satisfaction is an important consideration because it is significantly correlated with compliance and better outcomes. Financial pressures contribute to decision making: although selecting the less expensive inhaler device might reduce direct treatment costs, it can have a large impact on disease control and the patient's well-being. Switching may be associated with a poor inhalation technique, reduced disease control and quality of life, increased use of other treatments and health care resources, and a greater chance of unsuccessful treatment. Nonconsensual switches can result in patient discontent, reduced confidence in the medication, and uncertainty regarding the degree of disease control. It is recommended that patients with stable disease remain on their current device. If a switch is considered, the patient should be consulted and the physician should take into account the patient's preference, their ability to correctly use the device, and the availability of the preferred drug in the preferred device. © 2014 S. Karger AG, Basel.
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