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Non-T2 asthma: approach & management

Ji-yong Moon
  • : 대한결핵 및 호흡기학회
  • : 대한결핵및호흡기학회 추계학술발표초록집 127권0호
  • : 프로시딩
  • : 2019년 11월
  • : 31-37(7pages)

DOI


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UCI(KEPA)

간행물정보

  • : 의약학분야  > 내과학
  • :
  • :
  • : 연간
  • :
  • :
  • : 학술지
  • : 프로시딩
  • : 1960-2019
  • : 6720


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1Current diagnosis and management of hypersensitivity pneumonitis

저자 : Luca Richeldi

발행기관 : 대한결핵 및 호흡기학회 간행물 : 대한결핵및호흡기학회 추계학술발표초록집 127권 0호 발행 연도 : 2019 페이지 : pp. 2-2 (1 pages)

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Despite a growing literature, hypersensitivity pneumonitis continues to resist our best attempts to develop an accurate, reproducible case definition for this disease. Making a diagnosis of hypersensitivity pneumonitis is challenging because it is often shadowed by marginal exposure histories, borderline antigen positivity or discordant imaging patterns and treatment decisions are often based on diagnostic probability rather than certainty. As in idiopathic pulmonary fibrosis, chest high-resolution computed tomography (HRCT), plays a central role in the initial evaluation of hypersensitivity pneumonitis and involves the identification of specific CT patterns. For many years, the presence of mosaic attenuation on CT has been widely accepted as a cardinal imaging feature of hypersensitivity pneumonitis.
The presence of mosaic attenuation is an often hotly debated observation in patients with fibrotic lung disease. Recent data reinforce the importance of making distinctions between different types of mosaic attenuation and provide radiologists with a specific imaging target to aim for, namely, the headcheese sign. The Fleischner Glossary of Terms for Thoracic Imaging provides radiologists with a toolbox for conveying interpretation and formulating a diagnosis.
Currently there are no approved therapies for hypersensitivity pneumonitis. Management involves identifying and eradicating the antigen from the patient's environment. Corticosteroids may be administered for acute symptomatic relief and in those patients with subacute progressive and chronic disease. While the management of acute hypersensitivity pneumonitis may be straightforward, chronic hypersensitivity pneumonitis does not always respond to corticosteroid treatment. Recent data indicate that anti-fibrotic therapy may be of benefit in patients affected by chronic hypersensitivity pneumonitis with a progressive disease course.

2The role of new drugs in MDR-TB treatment

저자 : Jeffrey S. Hafkin

발행기관 : 대한결핵 및 호흡기학회 간행물 : 대한결핵및호흡기학회 추계학술발표초록집 127권 0호 발행 연도 : 2019 페이지 : pp. 3-3 (1 pages)

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Up until this past decade, no new drug had been developed for the treatment of TB in over 40 years. Since then, several compounds have received stringent regulatory approval, including the diarylquinoline, bedaquiline, and the nitroimidazoles, delamanid and pretomanid. In addition, various agents have been repurposed specifically for the treatment of drug-resistant TB and are now recommended by the WHO, notably linezolid, clofazimine, and the carbapenems. Finally, a number of new compounds from different classes have entered into clinical development, including the DPRE1 Inhibitors (e.g. BTZ043, PBTZ169, OPC-167832, TBA7371), the oxazolidinones (e.g. sutezolid, delpazolid, contezolid), the imidazopyridines (e.g. telacebec), and the leucyl-tRNA synthetase inihibitors (GSK-656).

3Public health emergency preparedness & response in Korea

저자 : Ki-suck Jung

발행기관 : 대한결핵 및 호흡기학회 간행물 : 대한결핵및호흡기학회 추계학술발표초록집 127권 0호 발행 연도 : 2019 페이지 : pp. 4-10 (7 pages)

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4Clinical benefit of pirfenidone in IPF in Japanese experiences 90min

저자 : Arata Azuma

발행기관 : 대한결핵 및 호흡기학회 간행물 : 대한결핵및호흡기학회 추계학술발표초록집 127권 0호 발행 연도 : 2019 페이지 : pp. 13-13 (1 pages)

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IPF is an irreversible devastating pulmonary disease of unknown cause. Pirfenidone is a disease modulator with inhibition of decline in pulmonary functions, that was firstly available in Japan. Pirfenidone showed proof in attenuation in decline of FVC(VC) of patients with IPF in a clinical trial, that has led subsequently approval over the world.
Real life practice makes multivariate analysis leading to other parameters including DLco, 6mw distance, symptoms, quality of life, radiological findings, acute exacerbation, and comorbidities such as lung cancer, risk of surgical procedure, and lastly overall survival. How much dosage is beneficial to IPF patients?
Discussion will be continued in balance on risk and benefit. As drug development is globalized, the effectiveness of pirfenidone may depend on ethnic differences. We, all Asian need to share information about clinical practice across countries and times.

5Is it time for a paradigm shift in first line treatment of EGFR mutant NSCLC?

저자 : Darren Wan-teck Lim

발행기관 : 대한결핵 및 호흡기학회 간행물 : 대한결핵및호흡기학회 추계학술발표초록집 127권 0호 발행 연도 : 2019 페이지 : pp. 14-14 (1 pages)

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EGFR mutant NSCLC represents the majority of lung cancer in Asia. All generations of EGFR tyrosine kinase inhibitors have demonstrated excellent efficacy in advanced disease. Osimertinib was developed specifically to address T790M mutation, the dominant resistance mechanism following failure of 1st/2nd generation inhibitors. Moving the use of osimertinib to the first-line setting represents a paradigm shift in management of EGFR mt lung cancer, as it challenges current practice of sequencing EGFR inhibitors. The discussion will focus on recent overall survival data from FLAURA and its possible impact on existing practice in EGFR mutant NSCLC in Asia.

6New perspectives for the future treatment option in NSCLC

저자 : Natasha Leighl

발행기관 : 대한결핵 및 호흡기학회 간행물 : 대한결핵및호흡기학회 추계학술발표초록집 127권 0호 발행 연도 : 2019 페이지 : pp. 16-16 (1 pages)

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With the exciting evolution of treatment in advanced non-small cell lung cancer to incorporate either targeted therapy or immune-oncology, the future of lung cancer treatment continues to evolve. Currently we have seen the transition of immunotherapy from the palliative stage IV setting to the curative stage III setting after radical chemoradiation for unresectable stage III NSCLC. Also we have seen the impact of immunotherapy in stage IV small cell lung cancer, with approximately 15% of patients deriving major long term benefit from anti-PD-1 agents in the IMPower 133 and CASPIAN trials. The use of immunotherapy is moving towards earlier stage disease, with dramatic benefits seen with single agent (preoperative nivolumab) and combination chemo-immunotherapy as preoperative treatment in resectable NSCLC (NADIM trial). There are multiple ongoing trials exploring the impact of adjuvant and peri-adjuvant checkpoint inhibitors either as anti-PD-1 monotherapy, combination with chemotherapy or combination anti-PD-1/anti-CTLA-4 therapy in the curative setting.
In advanced disease, we must continue to develop our understanding of whether tumours are potentially sensitive to checkpoint inhibitors, and if not, why not. Is it a failure of antigen presentation or MHC machinery, a failure of T cell activation and infiltration or other challenges? With a better understanding of the immunogram of each person's tumour, we will be able to design strategies to overcome treatment resistance, turning “cold” tumours “hot”. These may include combinations of chemotherapy and immunotherapy, combinations of checkpoint inhibitors (e.g. LAG-3 and PD-1), and targeted agents with immunotherapy, (e.g. VEGF and PD-1 inhibitors). All of these areas have growing promise with novel agents and ongoing trials. Cell therapeutics and vaccines have been more challenging to harness in lung cancer therapeutic development but ongoing studies may yet yield promise, including bespoke vaccines.

7Novel treatment strategies for mild asthma

저자 : Yeon-mok Oh

발행기관 : 대한결핵 및 호흡기학회 간행물 : 대한결핵및호흡기학회 추계학술발표초록집 127권 0호 발행 연도 : 2019 페이지 : pp. 18-23 (6 pages)

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8Optimal selection of inhalers in asthma patients

저자 : Yong Il Hwang

발행기관 : 대한결핵 및 호흡기학회 간행물 : 대한결핵및호흡기학회 추계학술발표초록집 127권 0호 발행 연도 : 2019 페이지 : pp. 24-30 (7 pages)

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9Non-T2 asthma: approach & management

저자 : Ji-yong Moon

발행기관 : 대한결핵 및 호흡기학회 간행물 : 대한결핵및호흡기학회 추계학술발표초록집 127권 0호 발행 연도 : 2019 페이지 : pp. 31-37 (7 pages)

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10Moving toward precision medicine in severe difficult asthma; a role of serum periostin

저자 : Hisako Matsumoto

발행기관 : 대한결핵 및 호흡기학회 간행물 : 대한결핵및호흡기학회 추계학술발표초록집 127권 0호 발행 연도 : 2019 페이지 : pp. 38-38 (1 pages)

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Biologics targeting type-2 inflammation, one of the key features of asthma, have introduced a new era for the management of patients with severe asthma who are inadequately controlled with high doses of inhaled corticosteroids and other controllers. However, these biologics are costly and need long-term usage, and responses to the biologics may vary in patients with severe asthma. Therefore it is necessary to find the most beneficial biologics in each patient, using biomarkers. Currently, clinically useful biomarkers to identify type-2 endotype are blood eosinophil counts and exhaled nitric oxide. However, no single biomarker is ideal and each has its own advantages and limitations, so that we need more biomarkers, including serum periostin. In addition, combination of biomarkers is much informative for precise endotyping, which may compensate for the drawbacks of each biomarker.
Periostin, a matricellular protein belonging to the fasciclin family, is a key molecule linking type-2 airway inflammation and airway remodeling. Fortunately, periostin can be detected in the blood and thus can be used to provide sustaining airway information on type-2 inflammation and remodeling. Serum periostin is elevated in the eosinophilic/type 2 subtype of severe asthma, and its levels remain relatively stable and reflect genetic backgrounds. This suggests that serum periostin may serve as a marker of geno-endophenotype with type-2 airway inflammation and thus could be a predictive marker of the long-term prognosis of asthma under treatment. Of interest, serum periostin levels are relatively lower in the overweight/obese population, which may partly explain the discrepancy between blood eosinophil counts and serum periostin levels. In this symposium, I would like to review characteristics and roles of type-2 biomarkers, including serum periostin, for precision medicine in severe difficult asthma.

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