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26Mar

High-Flow Nasal Cannula Therapy in ARDS Patients

Posted by: admin Categories: PHYSICAL REHABILITATION

We asked the participants if they agreed about the relevant indications or conditions that require HFNC. The top responses were COVID-19 (78%), post-extubation (65%), and do-not-intubate patients (64%). The lowest responses were pre-oxygenated patients before intubation (38%), obesity-induced hypoventilation syndrome (34%), and sleep apnea syndrome (33%). (See Table 1 and Figure 1).

Introduction

The high-flow nasal cannula (HFNC) has become an essential non-invasive oxygen therapy device. Recently, it has been used widely in clinical settings as a non-invasive respiratory support method to improve oxygenation in adult patients.¹ HFNC has several advantages over conventional low-flow devices (eg, nasal cannula or simple face masks): enhanced patient comfort, increased humidification, improved secretion clearance and reduced effort in breathing.^2,3 The HFNC system is a unique device that is simple and easy to use, needing only an active heated humidifier, flow generator, single circuit, and soft nasal cannula.⁴ This device was developed to maintain high oxygen flow and improve the efficiency of ventilation by delivering warmed and humidified oxygen with a flow rate as high as 60 L/minute and a fraction of inspired oxygen (FiO₂) of 0.21 to 1.0. An increased flow rate can help reduce inspiratory effort and improve dynamic lung compliance, which can lead to improving oxygenation and ventilation.^1,5,6 During the COVID-19 pandemic, several studies showed that the use of HFNC as an alternative oxygen device for respiratory failure patients can provide higher oxygen concentrations than can be achieved with conventional devices, reduce the need for endotracheal intubation, and decrease the length of stay in intensive care units (ICUs).^7–9 In addition, HFNC has a valuable effect in reducing anatomical dead space, which provides low positive end-expiratory pressure (PEEP) and can be more tolerable for patients with chronic obstructive pulmonary disease (COPD).¹⁰ Moreover, the immediate use of HFNC for postoperative respiratory failure patients was associated with lower risks of reintubation and respiratory failure.¹¹

Even though the use of HFNC is prevalent in clinical settings, RTs still lack evidence-based guidelines for implementing HFNC.¹² Moreover, HFNC is frequently utilized by RTs but controversy remains on the initiation, management and weaning of HFNC due to scant evidence.^12–14 A cross-sectional study of French ICU physicians found that there was a great deal of variability in the current use of HFNC, including the criteria for initiation and weaning.¹⁵ Furthermore, a global survey of intensive care unit (ICU) healthcare providers reported that there was considerable variation in the daily application of HFNC with regard to initial settings and management criteria for HFNC parameters.¹⁶ HFNC failure may result from these notable differences in clinical practice, which is probably due to lack of educational training and standardized protocols.¹⁷

Despite the wide use of HFNC and the studies exploring the benefits of using HFNC with ARDS patients, research into assessing the knowledge, practice, and barriers to using HFNC among respiratory therapists in Saudi Arabia is lacking. Therefore, this study aimed to assess the current practice of HFNC in multiple centers in Saudi Arabia and identify the barriers to using HFNC among respiratory therapists.

Methods

Study Design

In this cross-sectional study, a survey was distributed through an electronic platform SurveyMonkey between December 19, 2022, and July 15, 2023.

Instrument

Experts in the use of HFNC (namely ICU physicians, respiratory therapists, and ICU nurses) formulated this questionnaire, which was adapted and modified from previous studies.^8,15,16,18 Next, face and content validity were assessed by an expert panel and the survey was then pilot-tested. After receiving feedback from the experts, adjustments were made, and the survey was distributed. The survey consisted of six main parts:

The first part asked the participants about their demographic information (eg, gender, number of years working in critical care areas, and geographical location).
The second part focused on assessing the study participants’ knowledge of indications for the use of HFNC. This part consists of 13 statements with a five-point Likert scale ranging from 1 to 5 (1 = strongly agree; 5 = strongly disagree).
The third part consisted of four statements with a five-point Likert scale ranging from 1 to 5 (1 = strongly agree; 5 = strongly disagree). This section assessed whether respiratory therapists agree that 1) the HFNC device is tolerable for patients, 2) HFNC is used to help patients eat and speak, 3) HFNC improves dyspnea, and 4) HFNC is used to avoid the need for intubation and invasive mechanical ventilation.
The fourth part assessed the study participants’ ability to determine the timing for switching to HFNC, the most appropriate initial settings for HFNC, the management of patients on HFNC, and the criteria required for weaning.
The fifth part consisted of four statements to evaluate whether the study participants were aware of the criteria for HFNC failure and the time to intubate and use invasive mechanical ventilation.
The last part consisted of one question about barriers to HFNC use.

Data Collection and Sampling

A convenience sampling strategy was used to recruit the study participants, and the main target population for this study were respiratory therapists who work in Saudi Arabian hospitals and hold a bachelor degree. To reach a larger population of respiratory therapists, we distributed the survey through Saudi scientific non-profit organizations (eg, the Saudi Society for Respiratory Care) along with social media platforms (X and WhatsApp). In addition, each data collector visited and circulated the survey to respiratory therapists working at their nearby tertiary hospitals.

Data Analysis

The collected data were managed and analyzed using the Statistical Package for the Social Sciences (SPSS) version 27. Data were presented as means and standard deviation or frequency and percentages, as appropriate. A Chi-square test was used to compare RT staff who have existing HFNC protocols and those who do not. A p-value of <0.05 was considered statistically significant.

Ethical Approval

Before the commencement of the study, ethical approval was obtained from the Bioethical Committee at Batterjee Medical College (Reference Number RES-2022-0077).

Results

Participant Characteristics

In this study, 1001 RT practitioners completed the online survey. Over half of the participants were female (573, or 57.2%). The majority of our sample was staff specialists (824, or 82.3%), while directors of RT departments accounted for 29 (2.9%). High numbers of representatives were from the country’s Western and Central Regions (52.8% and 26.4%, respectively). More than half (56.1%) of the participants had one to five years of clinical experience. In addition, we documented the areas where the respiratory therapists were assigned, such as critical care (78.6%), non-critical care (65.5%), and ER (57.9%). Two-thirds of the respiratory therapists (659, or 65.8%) had received training on HFNC and 785 (78.4%) had used HFNC in clinical settings. (See Table 1).

Table 1 Demographic Data and Characteristics of Study Respondents (n = 1001)

Indications of Using High-Flow Nasal Cannula from the Perspective of RT Staff

Figure 1 Indications for using HFNC from the perspective of RT staff (n=1001).

Advantages of Using High-Flow Nasal Cannula

Four advantages of HFNC (ie, has high tolerability, helps maintain conversation and eating abilities, improves shortness of breath (SOB), and avoids intubation) were reported from the perspective of respiratory therapists. Participants strongly agreed that the advantages of HFNC were helping to maintain conversation and eating abilities (32.95%) and improving SBO (34.1%) (See Table 2 and Figure 2).

Table 2 Advantages of Using HFNC from the Perspective of RT Staff

Figure 2 Advantages of using HFNC from the prospective of RT staff (n=1001).

Initial Settings, Weaning and Disconnect of High-Flow Nasal Cannula

Surprisingly, 568 (57%) of RT staff do not follow a protocol for initiation, weaning and disconnection of HFNC with ARDS patients.

When starting HFNC, 40.2% of the participants started with FiO₂ of 61% to 80%. Additionally, a high percentage of RT staff (40.6%) started with a flow rate between 30 L/minute and 40 L/minute and a temperature of 37°C (57.7%). When weaning ARDS patients from HFNC, 482 (48.1%) recommended first reducing gas flow by 5–10 L/minute every two to four hours, followed by 362 (36.2%) who recommended first reducing FiO₂ by 5–10% every two to four hours. Moreover, 549 (54.8%) believed that ARDS patients could be disconnected from HFNC if they achieved a flow rate < 20 L/minute and FiO₂ <35%. (See Table 3).

Table 3 Clinical Practice of HFNC

In addition, we compared the responses between participants who followed a standardized protocol versus those who did not follow a protocol to initiate, wean and disconnect HFNC. (See Table 3).

Of the 402 RT staff who would start with FiO₂ between 61% and 80%, 289 (28.87%) reported not following a standardized protocol. Additionally, half of the RT staff (214, or 21.42%) who would start with a flow rate between 30 and 40 L/minute do not have a standardized protocol to follow. Among all participants, we observed a statistically significant difference between respiratory therapists who follow a protocol versus those who do not (p-value <0.001). For those who recommended first reducing gas flow by 5–10 L/minute every two to four hours when weaning ARDS patients, 356 (35.51%) did not follow a standardized protocol. Among all participants, we observed statistically significant differences between respiratory therapists who follow a protocol and those who do not follow a protocol (p-value <0.001). (See Table 3).

Criteria to Stop High-Flow Nasal Cannula and Intubate Acute Respiratory Distress Syndrome Patients

Regarding the criteria to stop providing HFNC and initiate intubation, 39.5% of the participants would stop providing HFNC if the patient paused or stopped breathing. Indeed, 34.7% of the participants would stop providing HFNC in cases of refractory hypoxemia (SpO2 < 90% with FiO₂ 100% and flow rate of 60 L/minute), 35% in cases of severe respiratory acidosis (pH is unacceptably low (<7.25) and the PaCO₂ is elevated), and 39.3% in cases of reduced level of consciousness (GCS score ≤8). (See Table 4).

Table 4 Criteria to Stop HFNC and Intubate ARDS Patients

Challenges in Using High-Flow Nasal Cannula

Regarding the challenges that impede the use of HFNC, participants ranked lack of knowledge, lack of devices, and the absence of protocol as the highest challenges (57.3%, 49.6, and 49%, respectively) while lack of evidence and diversity of HFNC devices were the lowest challenges 34.5% and 17.2%, respectively. (See Figure 3).

Figure 3 Challenges toward using HFNC from the perspective of RT staff (n=1001).

Discussion

To the best of our knowledge, this is the first national study to shed light on the knowledge, attitudes, and current practice of HFNC in ARDS patients among respiratory therapists in Saudi Arabia and the barriers to its use in clinical settings. The study findings revealed nuanced applications marked by significant endorsement in certain clinical scenarios and a lack of protocol adherence, underscoring the need for uniform, evidence-based guidelines and enhanced training for respiratory therapists.

A significant finding in our study is the prominent endorsement of HFNC use in COVID-19 patients, post-extubation cases, and do-not-intubate patients. These results corroborate existing literature that underscores HFNC’s role in enhancing oxygenation and reducing the effort of breathing in acute hypoxemic respiratory failure.2,3 Similarly, a cross-sectional study disclosed that respiratory physicians in Japan regarded COVID-19 as a primary indicator for HFNC application given its propensity to reduce the frequency of sustained sedation, physical restraint, and length of stay in the ICU compared to patients undergoing non-invasive ventilation (NIV).⁸ Nevertheless, the lower agreement on HFNC’s application in pre-oxygenation, obesity-induced hypoventilation, and sleep apnea conditions indicates potential knowledge gaps or diverse clinical experiences that warrant further investigation.

HFNC therapy has garnered widespread clinical validation for its efficacy in the management of patients with ARDS. Its capacity to deliver a precise and adjustable flow of warmed, humidified oxygen optimizes patient comfort and oxygenation status and decreases respiratory distress symptoms and the risk of endotracheal intubation.^19,20 Within the scope of the present study, a substantial level of consensus was observed among participants, indicating that HFNC application is associated with a notable amelioration of SOB while concurrently preserving speech and eating capabilities. In line with these findings, previous literature has demonstrated the superiority of HFNC over alternative non-invasive respiratory modalities, underscored by its high patient tolerance and preservation of patients’ daily activities, emphasizing HFNC’s pivotal role in enhancing patient-centered outcomes.⁸

In the current study, significant discrepancies were observed in the setting of initial parameters, weaning strategies, and disconnection criteria pertaining to HFNC. Specifically, a majority of respiratory therapists reported an initial application of FiO₂ within the range of 60% to 80%, a flow rate of 30–40 L/minute, and a temperature of 37°C. Notably, these findings are inconsistent with established HFNC protocols, which advocate initiating FiO₂ at 1.00, a flow rate of 60 L/minute, and a temperature of 37°C.^21,22 Furthermore, a substantial proportion of respiratory therapists expressed a preference for initially weaning the flow rate by 5–10 L/minute every two to four hours, deviating from the guidelines stipulated by the Canadian Society of Respiratory Therapists, which prioritize reducing FiO₂ to less than 40% before commencing a gradual decrement in flow rate by increments of five.²¹ Analogously, heterogeneous practices were observed among French ICU physicians during the weaning process of HFNC settings.¹⁵ Despite these variations, a significant consensus emerged among over half of the respiratory therapists regarding the disconnection of HFNC, advocating for disconnection when the FiO₂ is below 35% and the flow rate falls below 20 L/minute, aligning with published guidelines.^1,21 A noteworthy revelation is the lack of adherence to standardized protocols for initiating, weaning, and disconnecting HFNC for ARDS patients. This inconsistency in clinical practices underscores the urgent need for the development and dissemination of evidence-based guidelines to enhance the quality and consistency of patient care.

Regarding the criteria dictating the transition from HFNC therapy to invasive mechanical ventilation in patients with ARDS, our study revealed a moderate consensus. This alignment was substantiated through the initiation of endotracheal intubation in cases of spontaneous breathing cessation, refractory hypoxemia, severe respiratory acidosis, or diminished consciousness. Concomitantly, a subsequent study yielded analogous outcomes, thereby affirming our findings. Notably, it illuminated the exacerbation of respiratory distress and the presence of bronchial congestion as substantive contributors to the ineffectiveness of HFNC therapy, consequently augmenting the imperative for invasive ventilation.¹⁵ Additionally, a retrospective analysis furnished empirical evidence identifying hypoxemic and hypercapnic respiratory failure as crucial indicators denoting the failure of HFNC therapy, particularly in scenarios wherein patients cannot sustain SpO₂ above 90% despite receiving maximal FiO₂. This insufficiency is accentuated by concomitant findings of arterial pH below 7.3 and respiratory rates exceeding 35 breaths per minute.²³ The diverse criteria employed by respiratory therapists to discontinue HFNC and commence intubation emphasize the need for standardization in this aspect. Precisely articulated and evidence-based criteria are instrumental in optimizing patient outcomes and mitigating the potential risks associated with delayed intubation.

Several barriers impede the widespread adoption of HFNC therapy in clinical settings. In the present study, RT staff identified a lack of knowledge, the unavailability of devices, and the absence of protocols as the foremost challenges hindering the optimal use of HFNC. In accordance with these results, existing literature has shown that a lack of skill and familiarity hampers the implementation of HFNC in the ICU.^24,25 Likewise, a pertinent study revealed that the absence of established objective criteria for initiating and managing HFNC settings significantly restricts its application, potentially leading to ineffective healthcare practices.²⁶ These findings underscore the necessity for targeted interventions to enhance the capabilities of respiratory therapists, ensure the availability of essential equipment, and establish evidence-based protocols and the importance of concerted efforts to fortify strengths and mitigate the challenges associated with HFNC application in clinical settings.

Strengths and Limitations

One of the notable strengths of this study is the breadth of the participant sample, offering a robust spectrum of insights and experiences from a diverse group of respiratory therapists. The comprehensive survey methodology enabled the capture of nuanced, multifaceted data, allowing for a granular analysis of HFNC practices and challenges. Additionally, the alignment of the study’s findings with existing literature accentuates its validity and contribution to the ongoing discourse on the clinical applications of HFNC. Nevertheless, the study has limitations. We did not assess the current practice and barriers of using HFNC from the prospective of physicians whose practices maybe different from RTs. The reliance on self-reported data introduces the potential for response biases, wherein participants might either consciously or unconsciously misreport their practices. The cross-sectional nature of the study design precludes causal inferences and the assessment of HFNC practice evolution over time. Moreover, the geographical and institutional diversity of participants, while a strength, also raises questions about the generalizability of the findings across different contexts and healthcare systems.

Conclusion

Respiratory therapists in Saudi Arabia demonstrated a profound understanding of the clinical advantages associated with the utilization of HFNC for adult patients with ARDS. However, significant discrepancies were observed concerning the setting of initial parameters, the formulation of weaning strategies, and the determination of disconnection criteria related to HFNC. These variations primarily stemmed from inadequate adherence to established protocols and limitations in available resources. Such observations underscore the imperative for the development and implementation of standardized, evidence-based guidelines, alongside comprehensive training initiatives aimed at enhancing respiratory therapists’ compliance with HFNC protocols.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Ethical Approval

This study was approved from Bioethical Committee at Batterjee Medical College (Reference Number RES-2022-0077) and conducted in accordance with the Declaration of Helsinki. Informed consent was obtained from all RTs participated in the study.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Funding

There is no financial supporting body for this study.

Disclosure

The authors report no conflicts of interest in this work.

References

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2. Qaseem A, Etxeandia-Ikobaltzeta I, Fitterman N, Williams JW Jr, Kansagara D; Physicians CGCotACo. Appropriate use of high-flow nasal oxygen in hospitalized patients for initial or postextubation management of acute respiratory failure: a clinical guideline from the American College of Physicians. Ann Internal Med. 2021;174(7):977–984. doi:10.7326/M20-7533

3. Papazian L, Corley A, Hess D, et al. Use of high-flow nasal cannula oxygenation in ICU adults: a narrative review. Intensive Care Med. 2016;42(9):1336–1349. doi:10.1007/s00134-016-4277-8

4. Nishimura M. High-flow nasal cannula oxygen therapy devices. Respir Care. 2019;64(6):735–742. doi:10.4187/respcare.06718

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6. Mauri T, Turrini C, Eronia N, et al. Physiologic effects of high-flow nasal cannula in acute hypoxemic respiratory failure. Am J Respir Crit Care Med. 2017;195(9):1207–1215. doi:10.1164/rccm.201605-0916OC

7. Gürün A, Öz M, Erol S, Çiftçi F, Çiledağ A, Kaya A. High flow nasal cannula in COVID-19: a literature review. Tuberk Toraks. 2020;68(2):168–174. doi:10.5578/tt.69807

8. Koyauchi T, Suzuki Y, Inoue Y, et al. Clinical practice of high-flow nasal cannula therapy in COVID-19 pandemic era: a cross-sectional survey of respiratory physicians. Respir Invest. 2022;60(6):779–786. doi:10.1016/j.resinv.2022.08.007

9. Sayan İ, Altınay M, Çınar AS, et al. Impact of HFNC application on mortality and intensive care length of stay in acute respiratory failure secondary to COVID-19 pneumonia. Heart Lung. 2021;50(3):425–429. doi:10.1016/j.hrtlng.2021.02.009

10. Millar J, Lutton S, O’Connor P. The use of high-flow nasal oxygen therapy in the management of hypercarbic respiratory failure. Ther Adv Respir Dis. 2014;8(2):63–64. doi:10.1177/1753465814521890

11. Hernández G, Vaquero C, González P, et al. Effect of postextubation high-flow nasal cannula vs conventional oxygen therapy on reintubation in low-risk patients: a randomized clinical trial. JAMA. 2016;315(13):1354–1361. doi:10.1001/jama.2016.2711

12. Alnajada A, Blackwood B, Messer B, Pavlov I, Shyamsundar M. International survey of high-flow nasal therapy use for respiratory failure in adult patients. J Clin Med. 2023;12(12):3911. doi:10.3390/jcm12123911

13. Puah SH, Li A, Cove ME, et al. High-flow nasal cannula therapy: a multicentred survey of the practices among physicians and respiratory therapists in Singapore. Aust Crit Care. 2022;35(5):520–526. doi:10.1016/j.aucc.2021.08.001

14. Alnajada A, Shyamsundar M, Messer B, Pavlov I. North American Survey of High-Flow Nasal Cannula Therapy Use. A42 ARF/ARDS. American Thoracic Society; 2022:A5535–A5535.

15. Besnier E, Hobeika S, NSeir S, et al. High-flow nasal cannula therapy: clinical practice in intensive care units. Ann Intens Care. 2019;9:1–8.

16. Li J, Tu M, Yang L, et al. Worldwide clinical practice of high-flow nasal cannula and concomitant aerosol therapy in the adult ICU setting. Respir Care. 2021;66(9):1416–1424. doi:10.4187/respcare.08996

17. Wen R, Hu X, Wei T, et al. High-flow nasal cannula: evaluation of the perceptions of various performance aspects among Chinese clinical staff and establishment of a multidimensional clinical evaluation system. Front Med. 2022;9:900958. doi:10.3389/fmed.2022.900958

18. Hosheh O, Edwards CT, Ramnarayan P. A nationwide survey on the use of heated humidified high flow oxygen therapy on the paediatric wards in the UK: current practice and research priorities. BMC Pediatr. 2020;20(1):109. doi:10.1186/s12887-020-1998-1

19. Abdelbaky AM, Elmasry WG, Awad AH, Khan S, Jarrahi M. The impact of high-flow nasal cannula therapy on acute respiratory distress syndrome patients: a systematic review. Cureus. 2023;15(6):1.

20. Lee CC, Mankodi D, Shaharyar S, et al. High flow nasal cannula versus conventional oxygen therapy and non-invasive ventilation in adults with acute hypoxemic respiratory failure: a systematic review. Respir Med. 2016;121:100–108. doi:10.1016/j.rmed.2016.11.004

21. Ischaki E, Pantazopoulos I, Zakynthinos S. Nasal high flow therapy: a novel treatment rather than a more expensive oxygen device. Eur Respir Rev. 2017;26(145):170028. doi:10.1183/16000617.0028-2017

22. Vianello A, Arcaro G, Molena B, et al. High-flow nasal cannula oxygen therapy to treat patients with hypoxemic acute respiratory failure consequent to SARS-CoV-2 infection. Thorax. 2020;75(11):998–1000. doi:10.1136/thoraxjnl-2020-214993

23. Kang BJ, Koh Y, Lim C-M, et al. Failure of high-flow nasal cannula therapy may delay intubation and increase mortality. Intensive Care Med. 2015;41(4):623–632. doi:10.1007/s00134-015-3693-5

24. O’Brien SL, Haskell L, Tavender EJ, et al. Factors influencing health professionals’ use of high-flow nasal cannula therapy for infants with bronchiolitis–A qualitative study. Front Pediatr. 2023;11:1098577. doi:10.3389/fped.2023.1098577

25. Jackson JA, Spilman SK, Kingery LK, et al. Implementation of high-flow nasal cannula therapy outside the intensive care setting. Respir Care. 2021;66(3):357–365. doi:10.4187/respcare.07960

26. Horvat CM, Pelletier JH. High-flow nasal cannula use and patient-centered outcomes for pediatric bronchiolitis. JAMA Network Open. 2021;4(10):e2130927–e2130927. doi:10.1001/jamanetworkopen.2021.30927

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26Mar

New ultrasound technology may revolutionize respiratory disease diagnoses

Posted by: admin Categories: PULMONARY DISEASES

By evaluating sound vibrations produced by the airflow induced within the lungs and bronchial tree during normal breathing as well as those produced by the larynx during vocalizations, doctors can identify potential disease-related abnormalities within the respiratory system. In AIP Advances, researchers demonstrate the efficacy of ultrasound technology to detect low-amplitude movements produced by vocalizations at the surface of the chest. They also demonstrated the possibility of using the airborne ultrasound surface motion camera to map these vibrations during short durations so as to illustrate their evolution.

The thorax, the part of the body between the neck and abdomen, provides medical professionals with a valuable window into a patient's respiratory health. By evaluating sound vibrations produced by the airflow induced within the lungs and bronchial tree during normal breathing as well as those produced by the larynx during vocalizations, doctors can identify potential disease-related abnormalities within the respiratory system.

But, among other shortcomings, common respiratory assessments can be subjective and are only as good as the quality of the exam. While the advent of multipoint electronic stethoscopes has helped in terms of identifying abnormalities during normal breathing, there remains a dearth of technological devices that can help characterize surface vibrations produced by vocalizations.

In AIP Advances, by AIP Publishing, a team of French researchers demonstrated the efficacy of ultrasound technology to detect low-amplitude movements produced by vocalizations at the surface of the chest. They also demonstrated the possibility of using the "airborne ultrasound surface motion camera" (AUSMC) to map these vibrations during short durations so as to illustrate their evolution.

"AUSMC is a new imaging technology that allows the observation of the human thorax surface vibrations due to respiratory and cardiac activities at high frame rates of typically 1,000 images per second," said author Mathieu Couade. "The technology shares the physical principle of conventional ultrasound Doppler imaging, but it does not require a probe to be applied on the skin."

The researchers tested the AUSMC on 77 healthy volunteers to image the surface vibrations caused by natural vocalizations with the aim of reproducing the "vocal fremitus" -- vocalization-induced vibrations on the surface of the body -- as typically analyzed during physical examination of the thorax. Surface vibrations induced were detectable on all subjects, they reported.

"The spatial distribution of vibrational energy was found to be asymmetric to the benefit of the right size of the chest, and frequency dependent in the anteroposterior axis," said Couade. "As expected, the frequency distribution of vocalization does not overlap between men and women, with the latter being higher."

Ongoing clinical trials will use the AUSMC to focus on the identification of lung pathologies. But the researchers are hopeful that the technology, coupled with artificial intelligence algorithms, could usher in a new era of thorax examination in which vibration patterns can be isolated. This would offer a much better window on respiratory health and enable better diagnoses of respiratory diseases.

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23Mar

New classification of tuberculosis aims to improve focus on the early stages of disease

Posted by: admin Categories: PULMONARY DISEASES

University College London

A new way to classify tuberculosis (TB) that aims to improve focus on the early stages of the disease has been presented by an international team involving researchers at UCL.

The new framework, published in The Lancet Respiratory Medicine, seeks to replace the approach of the last half century of defining TB as either active (i.e., causing illness and potentially infectious to others) or latent (being infected with the bacterium that causes TB [M tuberculosis] but feeling well and not infectious to others) – an approach researchers say is limiting progress in eradicating the disease.

Of note, large surveys conducted in over 20 countries recently have shown than many people with infectious TB feel well.

Under the new classification, there are four disease states: clinical (with symptoms) and subclinical (without symptoms), with each of these classed as either infectious or non-infectious. The fifth state is M. tuberculosis infection that has not progressed to disease – that is, M tuberculosis may be present in the body and alive, but there are no signs of the disease that are visible to the naked eye, for example with imaging.

The researchers say they hope the International Consensus for Early TB (ICE-TB) framework, developed by a diverse group of 64 experts, will help lead to better diagnosis and treatment of the early stages of TB which have historically been overlooked in research.

TB remains the world's most deadly infectious disease currently and has caused over one billion deaths in the last 200 years. An estimated three million cases a year are not reported to health systems and more than half of these cases will be asymptomatic.

The international team was led by researchers at UCL, London School of Hygiene & Tropical Medicine, The Walter and Eliza Hall Institute (WEHI), University of Cape Town, Imperial College London and the South African Medical Research Council.

The binary paradigm of active disease versus latent infection has resulted in a one-size-fits-all antibiotic treatment for disease, but designed for those with the most severe form of disease. This leads to potential over-treatment of individuals with subclinical TB.

A key research priority now is to identify the best combination, dosage and duration of antibiotics to treat each TB state, as well as the benefits of treating the subclinical states."

Dr Hanif Esmail, co-lead author at the UCL Institute for Global Health and MRC Clinical Trials Unit at UCL

Professor Rein Houben (London School of Hygiene and Tropical Medicine), co-lead author of the paper, said: "While providing treatment to people who become very sick with TB has saved millions of lives we are not stopping transmission of the disease."

"To prevent transmission of TB, we need to move away from focusing just on the very sick and look at earlier disease states, identifying people who may be infectious for months or years before they develop TB symptoms.

"Our consensus framework replaces the old binary concept of 'active' versus 'latent' TB with a more detailed classification system that we hope, if widely adopted, could help to improve treatment for those with early-stage TB and drive forward efforts to eradicate the disease."

The framework was developed via a Delphi process designed to reach a consensus among a diverse group. The process began with a scoping review of papers and online surveys of experts and culminated in a two-day meeting in Cape Town, South Africa, of researchers from a range of disciplines as well as policymakers, clinicians, and TB survivors.

Dr Anna Coussens, co-lead author from WEHI, said: "One key finding in the consensus is moving the disease threshold and acknowledging that disease does not just start with symptoms or transmission, but when tissue is damaged.

"In time we hope our framework can contribute to TB elimination by leading to improved early diagnosis and treatment, optimizing patient outcomes and minimizing transmission."

The researchers noted that the disease process was non-linear – that people may fluctuate between infectious and non-infectious states, and between the presence and absence of symptoms or signs.

They also said that better diagnostic tools were needed to identify many of the TB states. For instance, there is currently no test to detect a viable M tuberculosis infection (i.e., one where the bacteria are physiologically active), as opposed to a non-viable infection or recent infection that has cleared.

The international team involved stakeholders from 19 countries including International Union Against TB and Lung Disease, The StopTB partnership, World Health Organization, FIND, National TB Programmes, TB Proof, and researchers from a number of universities and medical research institutes.

The work was supported by Wellcome, the National Institutes of Health/RePORT RSA, the Bill and Melinda Gates Foundation, the Medical Research Council, the European Research Council, and the National Health and Medical Research Council.

Source:

Journal reference:

Coussens, A. K., et al. (2024) Classification of early tuberculosis states to guide research for improved care and prevention: an international Delphi consensus exercise. The Lancet Respiratory Medicine. doi.org/10.1016/S2213-2600(24)00028-6.

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Frequent sneezing can be dangerous for health, if these symptoms are visible then do this immediately »

22Mar

Combining activity and grimace scores reflects perinatal stability in infants

Posted by: admin Categories: SPORTS & ATHLETICS

Committee Opinion No. 644. The Apgar score. Obstet. Gynecol. 126, e52–e55 (2015).

Apgar, V. A proposal for a new method of evaluation of the newborn infant. Curr. Res. Anesth. Analg. 32, 260–267 (1953).

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Identifying determinants of hospitalization influence »

22Mar

AstraZeneca to Initiate Trial for Triple-Combination Inhaled Therapy for Chronic Obstructive Pulmonary Disease

Posted by: admin Categories: PULMONARY DISEASES

AstraZeneca has announced it will initiate a phase 3 trial to investigate the effect of the triple-combination inhaled therapy budesonide/glycopyrronium/formoterol fumarate (BGF [Breztri Aerosphere]) on severe cardiopulmonary outcomes, including death, with individuals who have chronic obstructive pulmonary disease (COPD) and elevated cardiopulmonary risk, according to a press release from the company.¹

Image Credit: mi_viri - stock.adobe.com

“The 2024 GOLD Report highlights the treatment effect of non-pharmacologic interventions and inhaled triple combination therapies on mortality. The Report calls for a more proactive therapeutic approach to improve outcomes in COPD. If positive, the THARROS trial will provide critical evidence about the potential of single inhaler, triple combination therapy to reduce severe cardiopulmonary events and further advance treatment goals in COPD, including for patients with no history of exacerbations, for whom no evidence currently exists,” Fernando Martinez MD, MS, chief of the division of pulmonary and critical care medicine at Weill Cornell Medicine and New York-Presbyterian Hospital, said in the press release.¹

According to the CDC, the age-adjusted prevalence of COPD has remained unchanged from 2011 to 2022, with estimates higher for women across years. Further, the age-standardized COPD death rates in adults decreased from 1999 to 2021, with a smaller difference between men and women in 2021 compared with 2019, according to the data from the CDC.²

The THARROS study will be the first prospective trial to investigate the potential of inhaled triple therapy to reduce cardiopulmonary events in COPD. The study will investigate death from respiratory and cardiac causes will be the severe cardiopulmonary outcome measures. The trial will be multi-centered and double blinded and include 5000 individuals with COPD who have cardiopulmonary risk. Patients will be aged 40 to 80 years old and will receive the triple combination therapy or dual bronchodilator therapy, glycopyrronium/formoterol fumarate, according to the press release.¹

Furthermore, the company has announced that the first participants have also been dosed in the ATHLOS phase 3 clinical trial, investigating the triple therapy drug compared to inhaled corticosteroids and long-acting β-agonist, budesonide/formoterol fumarate (Symbicort; AstraZeneca), or the placebo on cardiopulmonary parameters, including hyperinflation and exercise endurance time, according to the press release. This study will include 180 individuals aged 40 to 80 years old.¹

Key Takeaways

The THARROS trial investigates the effect of Breztri Aerosphere (triple-combination therapy) on severe cardiopulmonary outcomes (including death) in high-risk COPD patients.
These trials address the need for a more proactive approach to COPD treatment, potentially reducing severe cardiopulmonary events.
Breztri is already approved for COPD maintenance treatment in many countries.

BGF is currently approved to treat COPD in 75 countries, including the United States. The drug is indicated for the maintenance treatment of individuals with COPD. The most common adverse reactions included upper respiratory tract infection, pneumonia, back pain, oral candidiasis, influenza, muscle spasms, urinary tract infection, cough, sinusitis, and diarrhea, according to the press release.¹

“Large outcomes trials have transformed the management of cardiovascular diseases by enhancing our understanding of the potentially broad impact of therapies targeting those diseases. Current evidence already supports a proactive treatment approach in COPD. Now THARROS is seeking to provide first-of-its-kind evidence to support a strategy of comprehensive cardiopulmonary risk reduction with a triple therapy,” David Berg, MD, MPH, associated physician in cardiovascular and critical care medicine at Brigham and Women’s Hospital at Harvard Medical School, said in the press release.¹

References

AstraZeneca announces initiation of THARROS – a Phase III clinical trial investigating the potential of Breztri to improve cardiopulmonary outcomes in people with COPD. News release. AstraZeneca. March 13, 2024. Accessed March 19, 2024. www.astrazeneca-us.com/media/press-releases/2024/astrazeneca-announces-initiation-of-tharros-a-phase-iii-clinical-trial-investigating-the-potential-of-breztri-to-improve-cardiopulmonary-outcomes-in-people-with-copd.html
Centers for Disease Control and Prevention. Chronic Obstructive Pulmonary Disease: National Trends. Updated February 29, 2024. Accessed March 19, 2024. www.cdc.gov/copd/data-and-statistics/national-trends.html

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21Mar

Google AI could soon use a person’s cough to diagnose disease

Posted by: admin Categories: PULMONARY DISEASES

Person coughing into their elbow while in bed. — The field of audiomics combines artificial intelligence tools with human sounds, such as a coughs, to evaluate health.Credit: Getty

A team led by Google scientists has developed a machine-learning tool that can detect and monitor health conditions by evaluating noises such as coughing and breathing. The artificial intelligence (AI) system¹, trained on millions of audio clips of human sounds, might one day be used by physicians to diagnose diseases including COVID-19 and tuberculosis and to assess how well a person’s lungs are functioning.

AI detects eye disease and risk of Parkinson’s from retinal images

This is not the first time a research group has explored using sound as a biomarker for disease. The concept gained traction during the COVID-19 pandemic, when scientists discovered that it was possible to detect the respiratory disease through a person’s cough².

What’s new about the Google system — called Health Acoustic Representations (HeAR) — is the massive data set that it was trained on, and the fact that it can be fine-tuned to perform multiple tasks.

The researchers, who reported the tool earlier this month in a preprint¹ that has not yet been peer reviewed, say it’s too early to tell whether HeAR will become a commercial product. For now, the plan is to give interested researchers access to the model so that they can use it in their own investigations. “Our goal as part of Google Research is to spur innovation in this nascent field,” says Sujay Kakarmath, a product manager at Google in New York City who worked on the project.

How to train your model

Most AI tools being developed in this space are trained on audio recordings — for example, of coughs — that are paired with health information about the person who made the sounds. For example, the clips might be labelled to indicate that the person had bronchitis at the time of the recording. The tool comes to associate features of the sounds with the data label, in a training process called supervised learning.

Google AI has better bedside manner than human doctors — and makes better diagnoses

“In medicine, traditionally, we have been using a lot of supervised learning, which is great because you have a clinical validation,” says Yael Bensoussan, a laryngologist at the University of South Florida in Tampa. “The downside is that it really limits the data sets that you can use, because there is a lack of annotated data sets out there.”

Instead, the Google researchers used self-supervised learning, which relies on unlabelled data. Through an automated process, they extracted more than 300 million short sound clips of coughing, breathing, throat clearing and other human sounds from publicly available YouTube videos.

Each clip was converted into a visual representation of sound called a spectrogram. Then the researchers blocked segments of the spectrograms to help the model learn to predict the missing portions. This is similar to how the large language model that underlies chatbot ChatGPT was taught to predict the next word in a sentence after being trained on myriad examples of human text. Using this method, the researchers created what they call a foundation model, which they say can be adapted for many tasks.

An efficient learner

In the case of HeAR, the Google team adapted it to detect COVID-19, tuberculosis and characteristics such as whether a person smokes. Because the model was trained on such a broad range of human sounds, to fine-tune it, the researchers only had to feed it very limited data sets labelled with these diseases and characteristics.

On a scale where 0.5 represents a model that performs no better than a random prediction and 1 represents a model that makes an accurate prediction each time, HeAR scored 0.645 and 0.710 for COVID-19 detection, depending on which data set it was tested on — a better performance than existing models trained on speech data or general audio. For tuberculosis, the score was 0.739.

An AI revolution is brewing in medicine. What will it look like?

The fact that the original training data were so diverse — with varying sound quality and human sources — also means that the results are generalizable, Kakarmath says.

Ali Imran, an engineer at the University of Oklahoma in Tulsa, says that the sheer volume of data used by Google lends significance to the research. “It gives us the confidence that this is a reliable tool,” he says.

Imran leads the development of an app named AI4COVID-19, which has shown promise at distinguishing COVID-19 coughs from other types of cough³. His team plans to apply for approval from the US Food and Drug Administration (FDA) so that the app can eventually move to market; he is currently seeking funding to conduct the necessary clinical trials. So far, no FDA-approved tool provides diagnosis through sounds.

The field of health acoustics, or ‘audiomics’, is promising, Bensoussan says. “Acoustic science has existed for decades. What’s different is that now, with AI and machine learning, we have the means to collect and analyse a lot of data at the same time.” She co-leads a research consortium focused on exploring voice as a biomarker to track health.

“There’s an immense potential not only for diagnosis, but also for screening” and monitoring, she says. “We can’t repeat scans or biopsies every week. So that’s why voice becomes a really important biomarker for disease monitoring,” she adds. “It’s not invasive, and it’s low resource.”

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21Mar

Chronic Obstructive Pulmonary Disease Market to Exhibit Substantial Growth by 2032, Assesses DelveInsight

Posted by: admin Categories: PULMONARY DISEASES

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How are companies such as Genentech, GlaxoSmithKline, Regeneron, Sanofi, MedImmune, and others influencing the COPD market?

LAS VEGAS, CALIFORNIA, UNITED STATES OF AMERICA, March 21, 2024 /EINPresswire.com/ -- The total market size of COPD in the 7MM was USD 12 billion in 2022 and is projected to grow during the forecast period (2023–2032) due to an increase in the diagnosed prevalent population of COPD along with the expected launch of emerging therapies such as Itepekimab (Sanofi/Regeneron Pharmaceuticals), Ensifentrine (RPL554) (Verona Pharma PLC), Dupilumab (Regeneron Pharmaceuticals/Sanofi), Benralizumab (AstraZeneca), Mepolizumab (GlaxoSmithKline), Acumapimod (Mereo BioPharma), and others.

DelveInsight’s Chronic Obstructive Pulmonary Disease epidemiology-based market forecast report includes a comprehensive understanding of these market drivers and how they will impact the overall COPD market size from 2019 to 2032, segmented into 7MM [the United States, the EU-4 (Italy, Spain, France, and Germany), the United Kingdom, and Japan].

Key Takeaways from the Chronic Obstructive Pulmonary Disease Market Report

As per the DelveInsight assessment, the diagnosed prevalent cases of COPD in the 7MM were approximately 33 million in 2022.

The estimates suggest the higher diagnosed prevalence of COPD in the United States with 18 million diagnosed cases in 2022 among the other 7MM countries which is expected to increase during the forecast period (2023–2032).

According to DelveInsight, the majority of cases of COPD are in females as compared to males, in the US. But in EU4 and the UK, and Japan the diagnosed cases of males represent the majority of the cases. Overall, in the 7MM, females are predominantly high in number.

COPD companies including Sanofi/Regeneron Pharmaceuticals (Itepekimab), Verona Pharma PLC (Ensifentrine), Regeneron Pharmaceuticals/Sanofi (Dupilumab), AstraZeneca (Benralizumab), GlaxoSmithKline (Mepolizumab), Mereo BioPharma (Acumapimod), and others are evaluating their lead candidates in different stages of clinical development. They aim to investigate their products for the treatment of COPD.

Chronic Obstructive Pulmonary Disease Market Dynamics

The chronic obstructive pulmonary disease market dynamics are shaped by a confluence of factors, including rising prevalence rates, technological advancements, evolving treatment approaches, and shifting patient demographics. As one of the leading causes of morbidity and mortality worldwide, COPD presents a significant burden on healthcare systems globally. This has spurred considerable research and development efforts by pharmaceutical companies to introduce innovative therapies that address the diverse needs of COPD patients.

Market growth is further fueled by the increasing adoption of combination therapies, such as inhaled corticosteroids and long-acting beta-agonists, which offer improved symptom management and disease control. Additionally, the emergence of novel biological therapies targeting specific inflammatory pathways has opened new avenues for personalized treatment approaches. These developments, coupled with a growing emphasis on early diagnosis and preventive measures, are expected to drive the COPD market forward, creating opportunities for market players to innovate and expand their offerings.

However, challenges persist in the COPD market, including stringent regulatory requirements, pricing pressures, and the need for robust clinical evidence to support the efficacy of new interventions. Moreover, disparities in healthcare access and awareness remain significant hurdles, particularly in developing regions. Addressing these challenges will be crucial for stakeholders in the COPD market to ensure equitable access to effective treatments while fostering sustainable growth in this dynamic and evolving landscape.

Download the report to understand which factors are driving COPD market trends @ Chronic Obstructive Pulmonary Disease Market Insights
Chronic Obstructive Pulmonary Disease Treatment Market

Numerous individuals with COPD experience mild forms of the condition that typically necessitate minimal intervention apart from quitting smoking. Even for those in more advanced stages, there are effective therapies available aimed at managing symptoms, slowing disease progression, decreasing the risk of complications and flare-ups, and enhancing the ability to engage in daily activities. The objective of COPD treatment is to improve breathing and restore regular functioning, with numerous treatments and lifestyle adjustments being beneficial. Patients might also consider exploring various natural and alternative treatment options. COPD treatment is centered on alleviating symptoms like coughing, and breathing difficulties, and preventing respiratory infections, often tailored to the specific stage of the disease. Certain lifestyle modifications are essential for COPD prevention, with quitting smoking being the cornerstone of any COPD treatment plan. Ceasing smoking can halt the worsening of COPD and improve respiratory capacity.

In April 2021, Chiesi Farmaceutici S.p.A. received approval from the European Commission to market beclometasone dipropionate, formoterol fumarate dihydrate, and glycopyrronium inhalation powder via the NEXThaler device. This is an ultra-fine blend of three medications combined into a single dry powder inhaler (DPI). The approval is for the ongoing treatment of adults with moderate to severe Chronic Obstructive Pulmonary Disease (COPD) who do not have sufficient response to a combination of an inhaled corticosteroid (ICS) and a long-acting beta2-agonist, or a combination of a long-acting beta2-agonist (LABA) and a long-acting muscarinic antagonist (LAMA).

Recent Developments in the Chronic Obstructive Pulmonary Disease Market

In February 2024, the FDA accepted to assessment of the application from Sanofi and Regeneron Pharmaceuticals, seeking to expand the label of Dupixent (dupilumab) to incorporate its use as an additional treatment for specific adults experiencing unmanageable COPD.

Emerging Chronic Obstructive Pulmonary Disease Therapies and Key Companies

Some of the drugs in the COPD pipeline include Itepekimab (Sanofi/Regeneron Pharmaceuticals), Ensifentrine (RPL554) (Verona Pharma PLC), Dupilumab (Regeneron Pharmaceuticals/Sanofi), Benralizumab (AstraZeneca), Mepolizumab (GlaxoSmithKline), Acumapimod (Mereo BioPharma), and others.
Itepekimab (SAR440340/REGN3500/Anti-IL-33 mAb) is a completely human monoclonal antibody designed to hinder interleukin-33 (IL-33), a protein thought to be central in both type 1 and type 2 inflammation. Administered through subcutaneous injection, preclinical investigations indicated that REGN3500 effectively blocked various indicators of these inflammatory responses. Regeneron and Sanofi are presently exploring REGN3500's potential in respiratory and dermatological conditions where inflammation is a significant factor. The drug is currently undergoing Phase III trials for COPD. Developed using Regeneron's specialized VelocImmune technology, which produces optimized fully human antibodies, REGN3500 is a collaborative effort between Regeneron and Sanofi as part of their global partnership.

Ensifentrine (RPL554) is a novel inhaled medication developed by Verona Pharma plc that acts as a dual inhibitor of both the phosphodiesterase 3 (PDE3) and phosphodiesterase 4 (PDE4) enzymes. This unique characteristic allows it to offer both bronchodilator and anti-inflammatory effects within a single compound, setting it apart from the current drug classes used to manage COPD, such as corticosteroids, beta2-agonists, and antimuscarinics. Verona Pharma plc has reported positive tolerability of ensifentrine in clinical trials involving approximately 3,000 participants.
The company is currently conducting a Phase III clinical program to assess the efficacy of nebulized ensifentrine for the maintenance treatment of COPD. Additionally, two other formulations of ensifentrine—dry powder inhaler (DPI) and pressurized metered-dose inhaler (pMDI)—are in Phase II development for COPD treatment.

In the third quarter of 2023, the FDA accepted Verona Pharma plc's New Drug Application for nebulized ensifentrine for COPD maintenance treatment. The FDA has set a target action date of June 26, 2024, for this application.

The other therapies in the COPD pipeline include

Astegolimab (MSTT1041A, AMG 282, RG6149): Genentech, Inc.
SB240563 (Mepolizumab)/NUCALA: GlaxoSmithKline
Dupilumab/SAR231893 (Dupixent): Regeneron Pharmaceuticals/Sanofi
Tozorakimab (MEDI3506): AstraZeneca/MedImmune LLC
FASENRA (Benralizumab): AstraZeneca
Tezspire (Tezepelumab): AstraZeneca
EP395: EpiEndo Pharmaceuticals
SelK2: Tetherex Pharmaceuticals
Mitiperstat (AZD4831): AstraZeneca
CHF6001/Tanimilast: Chiesi Farmaceutici S.p.A.
SNG001 (IFN-β): Synairgen Research Ltd.
Acumapimod (BCT-197): Mereo Biopharma
Zofin: Organicell Regenerative Medicine
PUL-042: Pulmotect, Inc.
MV130: Inmunotek S.L.
GSK3923868: GlaxoSmithKline
PUR1800: PULMATRiX
GRC 39815: GLENMARK PHARMACEUTICALS LTD
DMX-700: Dimerix Limited

The anticipated launch of these emerging therapies for COPD are poised to transform the market landscape in the coming years. As these cutting-edge therapies continue to mature and gain regulatory approval, they are expected to reshape the COPD market landscape, offering new standards of care and unlocking opportunities for medical innovation and economic growth.

Discover more about drugs for COPD in development @ Chronic Obstructive Pulmonary Disease Clinical Trials

Chronic Obstructive Pulmonary Disease: Overview

Chronic obstructive pulmonary disease is a prevalent, avoidable, and manageable condition distinguished by enduring respiratory issues and restricted airflow due to abnormalities in the airways or air sacs, typically stemming from significant exposure to harmful particles or gases. While primary among the cause is smoking tobacco, additional environmental factors such as exposure to biomass fuels and air contaminants could also play a role. Apart from these exposures, certain inherent factors make individuals more susceptible to COPD. These encompass genetic anomalies, irregular lung growth, and an accelerated aging process. The most prominent symptom of COPD is persistent and worsening difficulty in breathing. A cough accompanied by the production of phlegm occurs in around 30% of patients. These indications can fluctuate from day to day and might manifest many years before the onset of restricted airflow.

Chronic Obstructive Pulmonary Disease Epidemiology Segmentation

The COPD epidemiology section provides insights into the historical and current COPD patient pool and forecasted trends for individual seven major countries. It helps to recognize the causes of current and forecasted trends by exploring numerous studies and views of key opinion leaders.

The COPD market report proffers epidemiological analysis for the study period 2019–2032 in the 7MM segmented into:

Total COPD Diagnosed Prevalent Cases
COPD Gender-specific Diagnosed Prevalent Cases
COPD Age-specific Diagnosed Prevalent Cases
Diagnosed Prevalent Cases of COPD Based on Severity of Airflow
Diagnosed Prevalent Cases of COPD Based on Symptoms and Exacerbation History COPD

Scope of the Chronic Obstructive Pulmonary Disease Market Report

Chronic Obstructive Pulmonary Disease Therapeutic Assessment: Chronic Obstructive Pulmonary Disease current marketed and emerging therapies
Chronic Obstructive Pulmonary Disease Key Companies: Genentech, Inc., GlaxoSmithKline, Verona Pharma plc, Regeneron Pharmaceuticals, Sanofi, MedImmune LLC, EpiEndo Pharmaceuticals, Tetherex Pharmaceuticals, AstraZeneca, Chiesi Farmaceutici S.p.A., Synairgen Research Ltd., Mereo Biopharma, Organicell Regenerative Medicine, Pulmotect, Inc., Inmunotek S.L., PULMATRiX, GLENMARK PHARMACEUTICALS LTD, Dimerix Limited, ProterixBio, and others
Chronic Obstructive Pulmonary Disease Pipeline Therapies: Astegolimab (MSTT1041A, AMG 282, RG6149), SB240563 (Mepolizumab)/NUCALA, Ensifentrine (RPL554), Itepekimab/SAR440340/REGN3500, Dupilumab/SAR231893 (Dupixent), Tozorakimab (MEDI3506), FASENRA (Benralizumab), Tezspire (Tezepelumab), EP395, SelK2, Mitiperstat (AZD4831), CHF6001/Tanimilast, SNG001 (IFN-β), Acumapimod (BCT-197), Zofin, PUL-042, MV130, GSK3923868, PUR1800, GRC 39815, DMX-700, and others
Chronic Obstructive Pulmonary Disease Market Dynamics: Attribute Analysis of Emerging Chronic Obstructive Pulmonary Disease Drugs
Competitive Intelligence Analysis: SWOT analysis and Market entry strategies
Unmet Needs, KOL’s views, Analyst’s views, Chronic Obstructive Pulmonary Disease Market Access and Reimbursement

Table of Contents

1.
Chronic Obstructive Pulmonary Disease Market Key Insights
2.
Chronic Obstructive Pulmonary Disease Market Report Introduction
3.
Chronic Obstructive Pulmonary Disease Market Overview at a Glance
4.
Chronic Obstructive Pulmonary Disease Market Executive Summary
5.
Disease Background and Overview
6.
Chronic Obstructive Pulmonary Disease Treatment and Management
7.
Chronic Obstructive Pulmonary Disease Epidemiology and Patient Population
8.
Patient Journey
9.
Chronic Obstructive Pulmonary Disease Marketed Drugs
10.
Chronic Obstructive Pulmonary Disease Emerging Drugs
11.
Seven Major Chronic Obstructive Pulmonary Disease Market Analysis
12.
Chronic Obstructive Pulmonary Disease Market Outlook
13.
Potential of Current and Emerging Therapies
14.
KOL Views
15.
Unmet Needs
16.
SWOT Analysis
17.
Appendix
18.
DelveInsight Capabilities
19.
Disclaimer
20.
About DelveInsight

Chronic Obstructive Pulmonary Disease Pipeline Insight – 2024 report provides comprehensive insights about the pipeline landscape, including clinical and non-clinical stage products, and the key COPD companies, including Sanofi, Chiesi Farmaceutici S.p.A., United Therapeutics Corporation, Verona Pharma plc, Immunotek, Yungjin Pharm. Co., Ltd., Pulmotect, Inc., Tetherex Pharmaceutical, CSL Behring, AstraZeneca, Novartis, Genentech, Vertex Pharmaceuticals, EmeraMed, Afimmune, Mereo BioPharma, Synairgen, Adamis Pharmaceuticals, Quercegen Pharmaceuticals LLC, Regend Therapeutics, Meridigen Biotech Co., Ltd., Pulmatrix, Eisai, GlaxoSmithKline, EpiEndo Pharmaceuticals, 3SBio, OmniSpirant, Foresee Pharmaceuticals, Amgen, Organicell Regenerative Medicine, Arrowhead Pharmaceuticals, ProterixBio, RS BioTherapeutics, MitoRx, C4X Discovery, Respiratorius, ARK biosciences, Incannex, GNI Pharma, Celon pharma, Alveolus Bio, Kinaset therapeutics, Landos Biopharma, Parion Sciences, KeyMed Biosciences, Bioneer corporation, AlgiPharma, Palobiofarma, Dimerix Bioscience, Glenmark Pharmaceuticals, among others.

About DelveInsight

DelveInsight is a leading Business Consultant, and Market Research firm focused exclusively on life sciences. It supports pharma companies by providing comprehensive end-to-end solutions to improve their performance. Get hassle-free access to all the healthcare and pharma market research reports through our subscription-based platform PharmDelve.

DelveInsight’s healthcare consulting services leverage our extensive industry expertise, market research capabilities, and data analytics to provide clients with practical, data-driven solutions. The consultants work closely with clients to understand their unique needs and challenges and to develop tailored solutions that meet their specific requirements. DelveInsight’s consulting services cover a range of areas, including market access, commercial strategy, product development, and regulatory affairs in the healthcare domain.

Shruti Thakur
DelveInsight Business Research LLP
+1 469-945-7679
www.delveinsight.com

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21Mar

Research: Pill Strengthens Patients with Severe Muscle Weakness

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For the thousands of people globally affected by the disease myasthenia gravis (MG), everyday activities become a struggle, and in severe cases, the disease can be life-threatening.

Until now, there has been no muscle-specific and effective treatment against this rare autoimmune disease that leads to severe weakening of the muscles and fatigue. But now, a team of researchers from Aarhus University reveals a breakthrough in the treatment of MG that could give hope to many patients worldwide.

"The patients simply became stronger because the new treatment improves the communication between motor nerves and muscle fibers," says Thomas Holm Pedersen, an associate professor at the Department of Biomedicine at Aarhus University, CEO of NMD Pharma, and the lead author of the study that has just been published in the journal Science Translational Medicine.

Focusing on the link between nerve cells and muscles

MG is a disease where the immune system attacks the connection between nerves and muscle cells. It can affect breathing and be life-threatening, and it was precisely these symptoms that the researchers aimed to combat by strengthening the function of the contact point between nerves and muscle cells.

During his PhD project at Aarhus University, Thomas Holm Pedersen discovered that the so-called CIC-1 chloride channels at the neuromuscular junction are crucial for muscle activation.

"This led to the idea of using the CI channels as a new treatment point for diseases where the neuromuscular connection is compromised, including myasthenia gravis," he explains.

And it proved to be a good idea. The researchers demonstrated that they could effectively strengthen the muscles' ability to respond to nerve impulses by targeting a treatment at the specific channel. This, in theory, could increase muscle strength and reduce fatigue in patients.

"As there were no medications targeting the Cl channel, we first had to find the right molecule that we could test in patients, which requires considerable work and various tests before the regulatory authorities allow testing in humans. We tested it on patients who had to take a tablet daily for their muscle weakness and fatigue, and we could see that the treatment concept worked. The patients became stronger.

Treatment without side effects?

This represents a significant advance in the treatment of MG. Not only because it was successful in increasing muscle strength among patients, but also because the treatment, unlike existing methods, may well prove to be free from side effects.

"We won't know for sure for a few years, after we've conducted more studies, but it looks really promising right now," says Thomas Holm Pedersen.

The breakthrough could result in a significant improvement in the quality of life for patients struggling with MG, but it is also a big leap forward in the understanding and treatment of other neuromuscular diseases.

The research team is currently planning more follow-up clinical trials, including another study on MG and one on the hereditary disease spinal muscular atrophy, which leads to muscle wasting.

According to Thomas Holm Pedersen, we may be on the verge of a paradigm shift in the treatment of MG and other serious neuromuscular diseases.

"This study summarizes years of work here at Aarhus University and NMD Pharma. We have proven that the method works in patients, and now we continue with the clinical trials to bring the drug to the patients and to explore its broader application," he says.

Behind the research result

Study type: Randomized, double-blind, placebo-controlled, three-way crossover comparison of two single oral doses of NMD670 and placebo in men and women with stable symptomatic MG

Partners: NMD Pharma

External funding: The study is financed by NMD Pharma

Conflict of interest: Thomas Holm Pedersen and several others are inventors on patents related to the treatment of neuromuscular disorders, which involve both specific compounds and manufacturing processes. The research is supported by NMD Pharma A/S, where many of the authors are or have been employed, and some have financial interests in the form of stock options. A few authors have received funding or have consultancy roles with NMD Pharma A/S.

Link to the scientific article: www.science.org/doi/10.1126/scitranslmed.adk9109?adobe_mc=MCMID%3D61181809243887096264036353964800578399%7CMCORGID%3D242B6472541199F70A4C98A6%2540AdobeOrg%7CTS%3D1710786479

About NMD Pharma

NMD Pharma was founded in 2015 and is headquartered in Aarhus. The company develops new treatments for neuromuscular diseases.

Founded by:

Investors:

Novo Holdings – a private equity fund owned by the Novo Nordisk Foundation.
Lundbeckfonden BioCapital – a capital fund owned by the Lundbeck Foundation. Invests in life science companies focusing on neuroscience.
INKEF Capital – a capital fund investing in life science companies in the USA and Europe.
The Roche Venture Fund – a capital fund owned by Roche. Invests in life science companies focusing on new technologies.
Jeito Capital – a capital fund investing in life science companies in Europe.
CAPNOVA – a capital fund investing in life science companies in Denmark.

NMD Pharma was established by researchers from the Department of Biomedicine at Aarhus University, where they have worked on developing new treatments for neuromuscular diseases.

NMD Pharma has a collaboration agreement with the university, which among other things gives NMD Pharma access to the university's laboratory facilities.

NMD Pharma also has a number of employees who are affiliated with Aarhus University. These employees work on both research and development projects.

/Public Release. This material from the originating organization/author(s) might be of the point-in-time nature, and edited for clarity, style and length. Mirage.News does not take institutional positions or sides, and all views, positions, and conclusions expressed herein are solely those of the author(s).View in full here.

« Dysphagia in patients with severe COVID-19: a retrospective study

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Chronic Obstructive Pulmonary Disease Market to Exhibit Substantial Growth by 2032, Assesses DelveInsight »

19Mar

Ultrasound technology shows promise in detecting thoracic surface vibrations

Posted by: admin Categories: PULMONARY DISEASES

American Institute of Physics

AUSMC is a new imaging technology that allows the observation of the human thorax surface vibrations due to respiratory and cardiac activities at high frame rates of typically 1,000 images per second. The technology shares the physical principle of conventional ultrasound Doppler imaging, but it does not require a probe to be applied on the skin."

Mathieu Couade, Author

The researchers tested the AUSMC on 77 healthy volunteers to image the surface vibrations caused by natural vocalizations with the aim of reproducing the "vocal fremitus" – vocalization-induced vibrations on the surface of the body – as typically analyzed during physical examination of the thorax. Surface vibrations induced were detectable on all subjects, they reported.

Source:

Journal reference:

Wintzenrieth, F., et al. (2024) Airborne ultrasound for the contactless mapping of surface thoracic vibrations during human vocalizations: A pilot study. AIP Advances. doi.org/10.1063/5.0187945.

« This 3-in-1 Supplement Is Said to Relieve Stress Within the Hour

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Lancet Study Reveals Over 80% of TB Patients Do Not Show Persistent Cough, Other Warning Signs of TB »

19Mar

Ultrasound Tech May Transform Respiratory Disease Diagnosis

Posted by: admin Categories: PREVENTION & WELLBEING

WASHINGTON, March 19, 2024 – The thorax, the part of the body between the neck and abdomen, provides medical professionals with a valuable window into a patient's respiratory health. By evaluating sound vibrations produced by the airflow induced within the lungs and bronchial tree during normal breathing as well as those produced by the larynx during vocalizations, doctors can identify potential disease-related abnormalities within the respiratory system.

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Fuel poverty scheme helping nurses to make ‘unbelievable difference’ »

19Mar

Idiopathic Pulmonary Fibrosis Treatment Market is anticipated to surpass US$7.585 billion by 2029 at a CAGR of 11.87%

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The idiopathic pulmonary fibrosis market is anticipated to grow at a CAGR of 11.87% from US$3.459 billion in 2022 to US$7.585 billion by 2029.

The idiopathic pulmonary fibrosis market is anticipated to grow at a CAGR of 11.87% from US$3.459 billion in 2022 to US$7.585 billion by 2029.”

— Knowledge Sourcing Intelligence

NOIDA, UTTAR PARDESH, INDIA, March 19, 2024 /EINPresswire.com/ -- According to a new study published by Knowledge Sourcing Intelligence, the idiopathic pulmonary fibrosis market is projected to grow at a CAGR of 11.87% between 2022 and 2029 to reach US$7.585 billion by 2029.

Older persons are mostly affected by Idiopathic Pulmonary Fibrosis (IPF), a progressive lung disease for which there is no known cause. Breathing becomes more difficult as a result of the lung tissue being thicker and more rigid. Breathlessness, a chronic dry cough, exhaustion, and finally respiratory collapse are some of the symptoms. Although environmental variables and genetic predisposition may play a role, the precise explanation is yet unknown. Lung function examinations and imaging tests are necessary for the diagnosis, which frequently entails ruling out other illnesses. Treatment options include medication, oxygen therapy, pulmonary rehabilitation, and, in extreme circumstances, the possibility of a lung transplant, all of which are intended to manage symptoms and delay the progression of the disease.

The long-term, progressive lung illness known as idiopathic pulmonary fibrosis (IPF) is characterized by lung tissue scarring, which results in decreased oxygen supply and rigidity. It is yet unknown what causes it, which is why it is called "idiopathic." Breathlessness, a chronic cough, and exhaustion are among the symptoms, which usually get worse with time. With a median survival of 2–5 years after diagnosis, IPF primarily affects elderly persons and has a bad prognosis. Treatment includes pulmonary rehabilitation, lung transplant in severe cases, and drugs such as nintedanib and pirfenidone to control symptoms and halt the progression of the disease. To improve patient outcomes, research keeps looking into novel treatments and deepens our understanding of the underlying mechanisms driving the disease.

The market is witnessing multiple collaborations and technological advancements, for instance In January 2023 The US FDA gave Lotus Pharmaceutical's Abbreviated New Drug Application (ANDA) for Nintedanib Capsules, a generic form of Boehringer Ingelheim's OFEV^®, preliminary clearance. The generic Nintedanib Capsules will be introduced by the company as soon as possible.

Access sample report or view details: www.knowledge-sourcing.com/report/global-idiopathic-pulmonary-fibrosis-treatment-market

The idiopathic Pulmonary Fibrosis (IPF) market is expected to have significant growth in the drug class sector. Pharmaceutical companies are constantly developing new medications that target inflammation and fibrotic pathways as a result of continuous research and development activities. This expands the therapy options available to patients. Advances in early diagnosis and personalized therapy also play a part in the growing use of pharmaceutical interventions. The Drug class sector exhibits substantial potential for expansion, driven by innovation and the ongoing pursuit of effective medicines to enhance patient outcomes and quality of life in the management of IPF, despite obstacles such as high treatment costs and restricted therapeutic alternatives.

Based on drug type, the market for idiopathic pulmonary fibrosis (IPF) is expected to rise, with pirfenidone and nintedanib being key players. Because of its effectiveness and tolerability, pirfenidone—which has anti-fibrotic and anti-inflammatory qualities—has become a mainstay treatment. Tyrosine kinase inhibitor nintedanib, on the other hand, provides a unique mechanism that targets the advancement of fibrosis. Although both medications have shown effectiveness in delaying the course of sickness, nitedanib's distinct mechanism might contribute to the growth of its market. Nonetheless, pirfenidone's lengthier clinical history and established commercial presence might help it maintain its relevance. Ultimately, each segment's growth trajectory will be determined by patient preferences, developing clinical evidence, and market factors.

Based on end-users, Due to several factors, the hospital segment in the idiopathic pulmonary fibrosis (IPF) market is expected to increase significantly. Hospitals provide specialized care through interdisciplinary teams and are major centers for the diagnosis, treatment, and management of complicated respiratory disorders like IPF. As treatment options and diagnostic technology progress, hospitals become the main hubs for complete IPF care. The need for IPF-related services is further fueled by the increased need for hospital admissions and treatments brought on by the growing prevalence of IPF. Furthermore, hospitals frequently have access to clinical trials and cutting-edge therapies, which draws individuals looking for the best care possible for their ailments.

Based on geography the idiopathic pulmonary fibrosis (IPF) market in the Asia-Pacific region is expanding significantly due to factors such as escalating healthcare costs, aging populations, and more awareness. Access to cutting-edge therapies and enhanced diagnostic methods both support the growth. Governmental programs to combat respiratory illnesses and improve healthcare facilities also contribute to the market's expansion. Pharmaceutical businesses and academic institutions working together to promote research and development can result in new remedies that are tailored to the unique needs of the area. Notwithstanding obstacles such as inadequate knowledge and problems with reimbursement, the Asia-Pacific IPF market exhibits encouraging growth prospects.

As a part of the report, the major players operating in the Idiopathic Pulmonary Fibrosis (IPF), market that have been covered are Boehringer Ingelheim GMBH, Bristol-Myers Squibb Company, Biogen, Cipla, Hoffman-La Roche AG, Fibrogen Inc, Galapagos NV, Medicinova Inc., Novartis AG, Prometic Life sciences Inc.

The market analytics report segments the Idiopathic Pulmonary Fibrosis (IPF), market on the following basis:

• BY TREATMENT TYPE

o Drug class

o Oxygen Therapy

o Lung Transplant

o Others

• BY DRUG TYPE

o Pirfenidone

o Nintedanib

• BY END-USER

o Hospital

o Clinic

• BY GEOGRAPHY

o North America

• USA

• Canada

• Mexico

o South America

• Brazil

• Argentina

• Others

o Europe

• Germany

• France

• UK

• Others

o Middle East and Africa

• Saudi Arabia

• UAE

• Others

o Asia Pacific

• China

• India

• Japan

• South Korea

• Taiwan

• Thailand

• Indonesia

• Others

Companies Profiled:

• Boehringer Ingelheim GMBH

• Bristol-Myers Squibb Company

• Biogen

• Cipla

• Hoffman-La Roche AG

• Fibrogen, Inc.

• Galapagos NV

• Medicinova, Inc.

• Novartis AG

• Prometic Life sciences Inc.

Explore More Reports:

• Cystic Fibrosis Market: www.knowledge-sourcing.com/report/cystic-fibrosis-market

• Idiopathic Pulmonary Fibrosis Diagnostic And Treatment Market: www.knowledge-sourcing.com/report/idiopathic-pulmonary-fibrosis-diagnostic-and-treatment-market

• Melanoma Treatment Market: www.knowledge-sourcing.com/report/melanoma-treatment-market

Ankit Mishra
Knowledge Sourcing Intelligence LLP
+1 850-250-1698
email us here
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