Persons With Chronic Obstructive Pulmonary Disease and High Levels of Activation Improved Their Physical Activity Skills After an Educational Session.

Background: Daily physical activity is part of the self-management of patients with chronic obstructive pulmonary disease (COPD), and didactic information sessions may be insufficient for the provision of these skills. Prior activation can determine sensitivity to these sessions. We evaluated whether the activation in patients with COPD, as measured by the Patient Activation Measure (PAM)-13 questionnaire, determined their responses to an educational group session on physical activity (PA), which were measured with actigraphy by the number of steps/day. Methods: We conducted an uncontrolled clinical trial in an outpatient clinic with 75 patients with nonexacerbating COPD (forced expiratory volume in 1 second 30%-80%) who were selected consecutively. Patients were provided with an actigraph that they used for 15 days and completed the PAM-13 questionnaire. On the eighth day, they attended a group educational session where they were given PA information. We compared the changes in activity after the session by pooled PAM levels and the correlation between the change in the number of steps/day and the PAM-13 questionnaire. Results: A total of 26 patients had activation levels of 1-2, while 49 patients had levels of 3-4. After the session, patients in Levels 1-2 decreased their number of steps (-596±42), while those in Levels 3-4 increased them (680±253, p<0.01). The level of activation was positively correlated with change in the number of steps/day (p<0.05). Conclusion: COPD patients with greater activation showed greater improvements in daily PA after a group educational session.

Silica crystals activate toll-like receptors and inflammasomes to promote local and systemic immune responses in zebrafish.

Silica crystals are potent activators of the inflammasome that cause a fibrotic lung disease, called silicosis, with no effective treatment available. We report here that injection of silica crystals into the hindbrain ventricle of zebrafish embryos led to the initiation of local and systemic immune responses driven through both Toll-like receptors (TLR)- and inflammasome-dependent signaling pathways, followed by induction of pro-fibrotic markers. Genetic and pharmacological analysis revealed that the Nlrp3 inflammasome regulated silica crystal-induced inflammation and pyroptotic cell death, but not emergency myelopoiesis. In addition, Cxcl8a/Cxcr2-dependent recruitment of myeloid cells to silica crystals was required to promote emergency myelopoiesis and systemic inflammation. The zebrafish model of silicosis developed here shed light onto the molecular mechanisms involved in the activation of the immune system by silica crystals.

Inhaled corticosteroids in asthmatic children: are they as safe in infants and preschoolers as in older children? A review.

Inhaled corticosteroids (ICS) are the cornerstone of asthma management both in adults and in children. There are some adverse effects related to the use of these drugs in all ages. Those adverse effects can be local or systemic. From the paediatric point of view, the main worry relates to the effect on growth and on the integrity of the HPA-axis. At the recommended doses, their effect on the latter is not clinically relevant and the slight modification of cortisol levels which occurs while taking them reflects their presence in blood. Although there is a slowing down on growth velocity, this is reduced to the first months of treatment which are followed by a catch up: there is quite consistent data supporting their lack of significant effect on the final height. Other adverse effects which may appear in relation to ICS treatment in children, including infants, are mild or very sporadic. However, it is important to bear in mind that a small proportion of asthmatic children may have a certain idiosyncrasy which makes them especially sensitive to ICS. Furthermore, a close follow up is warranted when, due to the disease severity, higher than the recommended doses of ICS are administered.