Lung Regeneration Closer to Reality after New Discovery

Researchers from Weill Cornell Medical College say they have taken an important step forward in their quest to "turn on" lung regeneration - a discovery that could lead to treatment for millions of people suffering from respiratory disorders.

In the journal Cell, the research team claims that they have discovered the biochemical signals in mice that initiate the regeneration of new lung alveoli: the tiny, numerous sacs within the lung where oxygen exchange occurs. Specifically, they found that regenerative signals originate from the specialized endothelial cells that line the interior of blood vessels in the lung.

Though it has been long known that mice can regenerate and expand the capacity of one lung if the other is missing, this study now pinpoints the molecular triggers that initiate this process, and the researchers believe these findings hold relevance for humans.

According to lead author, Dr. Shahin Rafii, "Several adult human organs have the potential upon injury to regenerate to a degree, and while we can readily monitor the pathways involved in the regeneration of liver and bone marrow, it is much more cumbersome to study the regeneration of other adult organs, such as the lung and heart.”

For the study, Dr. Bi-Sen Ding, first author of this paper, removed the left lungs of mice and studied the biochemical process of subsequent regeneration of the remaining right lung. Prior research has shown that when the left lung of mice is removed, the right lung regenerates by 80 percent, effectively replacing most of the lost alveoli.

htclick for the complete article on lungs




The researchers found that removal of the left lung triggers receptors on lung endothelial cells that respond to vascular endothelial growth factor and basic fibroblast growth factor. Activating these receptors promotes the creation of another protein known as MMP14. The researchers discovered that MMP14, by releasing epidermal growth factors, sparks the generation of new lung tissue.

The next step for researchers will be to determine in MMP14 and other unrecognized angiocrine factors are responsible for lung regeneration in humans as well as mice. According to Dr. Ding, "We believe the same process goes on in humans, although we have no direct evidence yet.” The study’s authors theorize that patients with COPD have so much damage to their lung endothelial cells that they no longer produce the proper inductive signals, thus impairing lung regeneration.

Co-author of the study, Dr. Zev Rosenwaks theorizes that, “"Perhaps replacement of angiocrine factors, or transplantation of normal lung endothelial cells derived from pluripotent stem cells, could restore lung regeneration. Currently, we are generating pluripotent stem cells derived from patients with genetic pulmonary disorders to identify potential pathways, which may ultimately enhance our understanding of how lung endothelial cells may improve lung function in these patients."

new Emphysema Treatments with valves

Pulmonx Reports New Publication Confirms Efficacy of Emphysema Treatment

Zephyr Endobronchial Valve (EBV) therapy guided by Chartis Assessment is effective in a broad range of patients 

 

 

May 10, 2012- Pulmonx, an emerging leader in interventional pulmonology, announced today that the European Respiratory Journal has published the results of the Chartis Multi-Centre study. The study is the first to combine the Chartis Pulmonary Assessment System and Zephyr EBV treatment for patients with advanced emphysema. The published results of the study demonstrate that in patients who achieve volume reduction post Endobronchial Valve treatment, the majority get clinically significant responses in lung function, exercise tolerance and quality of life measures. After detailed review of the U.S. and European VENT data, a much broader profile of patient characteristics was identified for potential inclusion; including patients that would have been excluded in the previous studies.


"Using the Chartis system to reliably plan EBV treatment can provide very real benefits for emphysema patients by relieving the hyperinflation and providing clinical benefit. This is a welcome advance for patients who have very few treatment options available to them" said Professor Felix Herth, MD, PhD., FCCP, Chairman and Head of Pneumology and Respiratory Care at Thoraxklinik, University of Heidelberg, Germany. "I believe that the publication of the results of the study will lead to Chartis and EBV treatment becoming a standard-of-care in the management of emphysema," he continued.

About the European Respiratory Journal publication

The peer-reviewed clinical paper, "Radiological and Clinical Outcomes of Using Chartis to Plan Endobronchial Valve Treatment," demonstrates the ability of the bronchoscopic Chartis Pulmonary Assessment System to predict treatment response by determining the presence or absence of collateral ventilation (CV). In this study performed in Germany, The Netherlands and Sweden, 80 patients underwent a Chartis assessment prior to Zephyr endobronchial valve implantation. The patients predicted by Chartis to respond showed statistically significant target lobe volume reduction and associated improvement in lung function compared to those predicted not to respond.


There were no serious adverse events related to the Chartis System. Six patients experienced a pneumothorax, a known temporary complication of EBV therapy, and recovered with standard treatment with all patients demonstrating significant target lobe volume reduction.
The study highlights that the addition of the Chartis System to plan EBV therapy produces consistent, clinically meaningful results in a broad population of patients with emphysema, while also confirming the safety profile of Zephyr EBV therapy in treatment of emphysema.
"This publication is a milestone for us as it documents the safety and efficacy of Chartis guided Zephyr EBV therapy. It is particularly useful to have this peer-reviewed data published in the public domain as we make final preparations to begin our US trial," commented Michael A. Baker, President and CEO of Pulmonx.


The publication is available online at http://erj.ersjournals.com/content/early/2012/05/02/09031936.00015312.abstract

About Emphysema
Emphysema is a form of chronic obstructive pulmonary disease (COPD) that occurs when the air sacs in the lungs are gradually destroyed, leading to shortness of breath even while at rest. Globally over 30 million patients have been diagnosed with emphysema. COPD is a major cause of disability and a major public health problem. The World Health Organization ranks it as the fourth leading cause of death today and it is expected to become the third leading cause of death worldwide by 2030s. Most patients suffering from emphysema currently have few options for treatment. Emphysema is a major economic problem and a burden on the global healthcare system, due to millions of workdays missed, expensive and minimally effective therapies and frequent hospitalisations related to the disease.
About the Chartis and Zephyr Technologies

Emphysema patients suffer from hyperinflation--an increase in volume of the diseased portions of their lungs, which then compresses the healthier areas. This results in breathlessness and costly disability. Many patients cannot carry out even the most basic activities of everyday living, and may require supplemental oxygen. Zephyr endobronchial valves can reduce volume in the diseased portion of the lungs thereby improving the ability of the healthier portions of the lungs to function, and relieving the patient's symptoms, as well as allowing patients to increase their activity levels, promoting better overall health.
Some patients have extra airflow pathways between the lobes of their lungs, a condition known as "collateral ventilation". Large amounts of collateral ventilation can prevent the valves from working effectively by circumventing them.

The Chartis System includes a balloon catheter that is inserted into the airway and a simple, easy-to-use console that displays expiratory airflow, pressure and resistance, providing a quantitative measure of collateral ventilation.
Previously published studies on the Zephyr EBV have confirmed the safety of the treatment, as well as its effectiveness in a subset of emphysema patients. The challenge in applying the therapy to a broad population of emphysema patients has been the ability of physicians to plan valve treatments to account for anatomical variations in the lungs of individual patients which impact the effectiveness of the valves. The addition of the Chartis assessment now ensures that a very high percent of treated patients will experience benefit from EBV treatment.
About Pulmonx

Pulmonx, based in Redwood City, CA, and Peseux, Switzerland, is focused on developing and marketing minimally-invasive medical devices and technologies for the diagnosis and treatment of pulmonary disorders. The Chartis System and Zephyr EBV is the first effective diagnostic and therapeutic solution to the problem of emphysema-induced hyperinflation. www.pulmonx.com

The Zephyr EBV is an investigational device in the United States. Limited by U.S. law to investigational use. The Chartis System is for use/sale outside the United States only.

SOURCE: Pulmonx

        
        Pulmonx 
        Mike Baker, President & CEO 
        mbaker@pulmonx.com 
        Peseux, Switzerland 
        Phone: +41 32 557 5800 
        Redwood City, CA 
        Phone: +1 (0) 650 216-0150
        

Trigger Discovered Inside Blood Vessels of the Lung for lung regeneration

Trigger Discovered Inside Blood Vessels of the Lung for lung regeneration



A molecular trigger involved in lung regeneration has been uncovered. Investigators--including Dr. Ronald G. Crystal (Chief of Pulmonary and Critical Care Medicine) and Dr. Shahin Rafii (Professor of Medicine/Medicine & Genetics)-- have published their findings in Cell. The discovery is part of a labyrinth of advances toward a fuller understanding of the process of lung regeneration.

Lead investigator, Dr. Rafii (Arthur B. Belfer Professor of Genetic Medicine & Co-Director of WCMC’s Ansary Stem Cell Institute), explains that the pathways involved in the regeneration of liver and of bone marrow can be monitored readily, but it is “much more cumbersome” to study the process in adult organs such as the lung or heart. Using a mouse model, the investigators uncovered growth factor signals that trigger – or “turn on”-the generation of new lung alveoli. Lung alveoli are the numerous, tiny sacs within the lung where oxygen exchange takes place during inhalation and exhalation. The regeneration process the researchers have defined in the journal Cell involves specialized cells (known as endothelial cells), which line the interior of blood vessels in the lung: These endothelial cells--by producing specific growth factors know as angiocrine factors--trigger and sustain the generation of new lung alveoli.

It has been long-known that when a mouse is missing one of its lungs, the remaining lung has the capacity to expand and regenerate. It is speculated that humans may have the same potential, unless, or until, prevented by smoking, cancer, or other extensive chronic damage. Dr. Crystal, co-author of the study, notes there is no effective therapy for patients with COPD. “Based on this study,” he says, “I envision a day when patients with COPD and other chronic lung disease may benefit from treatment with factors derived from lung blood vessels that induce lung regeneration.”


see the news release on on lung regeneration at Cornell University

November is Lung Cancer and COPD Awareness Month

November is Lung Cancer and COPD Awareness Month

It may be no coincidence that November is both Lung Cancer Awareness Month and COPD Awareness Month. Lung cancer and COPD (chronic obstructive pulmonary disease) are two of the leading causes of death in America – and also among the most underappreciated. This November, the American Lung Association is shining a spotlight on these two deadly diseases, and what’s being done to reduce their burden on American lives and that of their loved ones. Two new pages on the American Lung Association website are now dedicated to raising awareness about COPD and lung cancer year round.

 

Lung Cancer – The Top Cancer Killer
Lung cancer is a tragic disease that takes a terrible toll on patients, as well as their loved ones. Lung cancer is the leading cancer killer in both men and women in the United States. In fact, more people die from lung cancer than colon, breast and prostate cancer combined. The American Lung Association has long been the leader in the fight against lung cancer and is taking new steps to help both patients and their families. Learn more.

COPD – Overlooked Lung ThreatDid you know that COPD is the third leading cause of death in the U.S.? Or that 12 million Americans have been diagnosed with COPD, while an estimated 12 million more have it, but have not been diagnosed? If you don’t, that’s part of the problem! Chronic obstructive pulmonary disease (COPD) – which includes emphysema and chronic bronchitis – can be prevented and is treatable, but only if people know about it. As part of our commitment to lung health, the American Lung Association is working to raise awareness of this overlooked lung health threat. We have also created useful tools for COPD patients and partnered with others to help people with COPD live healthier, more active lives. Learn more.

Register Today for the Yuma AZ Healthy Lung Expo

Register Today for the Yuma Healthy Lung Expo!

There is still space available for the Yuma Healthy Lung Expo!  Join us to learn more about lung health issues from great speakers, enjoy a delicious breakfast, spirometry testing, continuing education credits for healthcare professionals, door prizes and more!

Wednesday, November 16th
Pivot Point Conference Center
310 North Madison Avenue
Yuma, AZ

Keynote Speaker: Scott Cerreta, BS, RRT from the COPD Foundation will present  “COPD Co-morbidities and Optimal Care for Patient Self Management”

$5 for patients and caregivers 
$20 for healthcare professionals

Register online or register over the phone by calling 520-468-7458

 

For more information and the complete agenda visit www.breatheeasyaz.org
Questions?  Please call Amber at 520-468-7458

trigger generation of new lung alveoli

 trigger generation of new lung alveoli



In the Oct. 28 issue of the journal Cell, the research team reports that they have uncovered the biochemical signals in mice that trigger generation of new lung alveoli, the numerous, tiny, grape-like sacs within the lung where oxygen exchange takes place. Specifically, the regenerative signals originate from the specialized endothelial cells that line the interior of blood vessels in the lung.

While it has long been known that mice can regenerate and expand the capacity of one lung if the other is missing, this study now identifies molecular triggers behind this process, and the researchers believe these findings are relevant to humans.

"Several adult human organs have the potential upon injury to regenerate to a degree, and while we can readily monitor the pathways involved in the regeneration of liver and bone marrow, it is much more cumbersome to study the regeneration of other adult organs, such as the lung and heart," says the study's lead investigator, Dr. Shahin Rafii, who is the Arthur B. Belfer Professor of Genetic Medicine and co-director of the Ansary Stem Cell Institute at Weill Cornell Medical College.

"It is speculated, but not proven, that humans have the potential to regenerate their lung alveoli until they can't anymore, due to smoking, cancer, or other extensive chronic damage," says Dr. Rafii, who is also an investigator at the Howard Hughes Medical Institute. "Our hope is to take these findings into the clinic and see if we can induce lung regeneration in patients who need it, such as those with chronic obstructive pulmonary disease (COPD)."

"There is no effective therapy for patients diagnosed with COPD. Based on this study, I envision a day when patients with COPD and other chronic lung diseases may benefit from treatment with factors derived from lung blood vessels that induce lung regeneration," states Dr. Ronald G. Crystal, who is a co-author of this study and professor of pulmonary and genetic medicine at Weill Cornell.

breakthrough discovery in the understanding of lung regeneration

Stem cells used to regenerate lungs?

Stem cells used to regenerate lungs?

Working together, scientists and clinicians make research breakthrough that paves the way for novel therapies for respiratory diseases

Scientists at A*STAR'S Genome Institute of Singapore (GIS) and Institute of Molecular Biology (IMB), have made a breakthrough discovery in the understanding of lung regeneration. Their research showed for the first time that distal airway stem cells (DASCs), a specific type of stem cells in the lungs, are involved in forming new alveoli to replace and repair damaged lung tissue, providing a firm foundation for understanding lung regeneration.

Lung damage is caused by a wide range of lung diseases including influenza infections and chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD). Influenza infection induces acute respiratory distress syndrome (ARDS) which affects more than 150,000 patients a year in the US, with a death rate of up to 50 percent. COPD is the fifth biggest killer worldwide.

The team took a novel approach in tackling the question of lung regeneration. They cloned adult stem cells taken from three different parts of the lungs - nasal epithelial stem cells (NESCs), tracheal airway stem cells (TASCs) and distal airway stem cells (DASCs). Despite the three types of cells being nearly 99 percent genetically identical, the team made the surprising observation that only DASCs formed alveoli when cloned in vitro.

"We are the first researchers to demonstrate that adult stem cells are intrinsically committed and will only differentiate into the specific cell type they originated from. In this case, only DASCs formed alveoli because alveolar cells are found in the distal airways, not in the nasal epithelial or tracheal airway", said Dr Wa Xian, Principal Investigator at IMB. "This is a big advancement in the understanding of adult stem cells that will encourage further research into their potential for regenerative medicine."
Using a mouse model of influenza, the team showed that after infection, DASCs rapidly grow and migrate to influenza-damaged lung areas where they form "pods". These "pods" mature to new alveoli which replace the alveoli that were destroyed by the infection, leading to lung regeneration.

"We have harvested these "pods" to provide insight into genes and secreted factors that likely represent key components in tissue regeneration.
These secreted factors might be used as biological drugs (biologics) to enhance regeneration of the lung and airways," said Dr Frank McKeon, Senior Group Leader of the Stem Cell and Developmental Biology at GIS.
The research was jointly led by Dr Frank McKeon from GIS and Dr Wa Xian from IMB in collaboration with scientists at the National University of Singapore (NUS), and clinicians at the Harvard Medical School and the Brigham and Women's Hospital in Boston.

Prof Birgitte Lane, Executive Director of IMB, said, "This groundbreaking work is a fine example of collaborative research, which has brought us new insight into lung epithelial stem cells. This will have breakthrough consequences in many areas." Dr Edison Liu, Executive Director of GIS, added, "We will continue to seek impactful collaborations and build upon this research area where there is a need for novel therapies, which will offer hope for patients suffering from respiratory diseases."




click to read more on this adance in lung therapy in lung regeneration

UK HealthCare surgeons first to perform novel procedure for transplant patient

The patient “feels like a miracle,” after surgeons at UK HealthCare recently became the first ever to perform two specific procedures together as a bridge to lung transplantation.

Wanda Craig of Lexington is the first patient in history to receive these procedures, and at the age of 68, she is also the oldest living human to be bridged to transplant using an artificial lung device, also known as an extracorporeal membrane oxygenation (ECMO).

For more than 10 years, Craig has been treated for chronic obstructive pulmonary disease (COPD) and emphysema, getting oxygen assistance on an almost continual basis. In November 2010, her condition worsened and she was unable to do her usual everyday activities.

“I realized that things were really taking a turn for the worst when I was so out of breath from walking to the kitchen and didn’t have enough energy to even scoop ice cream out of the carton,” said Craig.

After being hospitalized and then transferred to the University of Kentucky Albert B. Chandler Hospital due to the severity of her case, Craig underwent the ECMO and heart procedures that saved her life.

“I feel like a miracle,” Craig said. “I feel like I owe so much to UK and the medical staff here.”

And a miracle she is – in more ways than one.

“Mrs. Craig, although treated for COPD and emphysema, actually suffered from pulmonary hypertension and when her situation became more severe that caused the right half of her heart to fail as the heart tried to work harder to get the oxygen it needed,” said Dr. Charles Hoopes, UK HealthCare’s new director of the UK Heart and Lung Transplant Program and the director of the Ventricular Assist Device (VAD) Program. “When the right side of the heart fails — called right ventricular failure — the blood cannot go through the lungs to fill the left side of the heart…with an empty left side of the heart there is less blood to pump to the body and the patient develops heart failure symptoms. This is not uncommon in end-stage lung disease.”

This is a major complication for many patients on the lung transplant waiting list. So, to circumvent this problem, Hoopes and Dr. Enrique Diaz, UK’s medical director of the lung transplant program, completed a procedure called an atrial septostomy, in which a small hole is created between the upper two chambers of the heart.  This procedure, combined with the use of an ECMO, allowed the blood to receive oxygen from an artificial lung device.

“These procedures are novel in terms of a bridge to transplantation, and the use of an artificial lung together with an atrial septostomy for cases of respiratory and right ventricular failure have not been performed together until now,” said Diaz.

“I immediately felt better the morning after my surgery and was able to walk 75 feet after less than 24 hours,” said Craig.

After only three days after the initial procedure, a new set of lungs became available for Craig and she underwent a double lung transplant.

“Because of her age, we were apprehensive about the ECMO procedure and lung transplant, however she proved to us that she is not the typical 68-year-old woman,” Hoopes said.

Proudly boasting about her two children, 3 grandchildren, and two great-grandchildren, Craig said they were her motivation to keep going and try and get better as fast as possible.

After being discharged from the hospital, Wanda and her husband celebrated their 50th wedding anniversary, and said that this experience has brought them closer together and helped their entire family appreciate the life and time they have together. After spending several holidays in the hospital over the past eight months, she is thankful she was able to be home for her milestone anniversary.

“More than anything I am looking forward to doing those normal everyday things like going to the grocery store and watching my grandson’s T-ball games,” Craig said. “And scooping my own ice cream. I could not have made it through this without the support and prayers from my family and friends.

“The care given to me while in the hospital was superb, and I’m thankful for my pulmonary physician that transferred me to UK HealthCare before it was too late for any lifesaving efforts. I’m also thankful for my donor family. I would not be here today without the knowledge of Dr. Hoopes and Dr. Diaz, and the entire transplant team. They took me under their wings in spite of all the risk involved – I will be in their debt the rest of my life.”

From UKNow

UK healthcare surgeons first to perform novel procedure for transplant patient

New meds for COPD coming ?

Tobacco consumption such as cigarette smoking is already known to cause a number of negative impacts on health as well as diseases including chronic obstructive pulmonary disease. The COPD is a severe health condition along with chronic bronchitis and emphysema. The disease sufferers are likely to experience complications in breathing and depend on artificial supply of oxygen. Countless people die because of the disease, across the world.

Recently, a team of German Scientists have carried out some laboratory experiments on mice where they acknowledged that presently several drugs have sufficient potential to reverse the incapacitating effects of emphysema. However, the team is not sure to yield similar results among humans.

Simultaneously, the study pinpointed attributes of an enzyme nitric oxide syntheses and claimed that iNOS is empowered to fluctuate levels of blood pressure and can introduce some deviations in pulmonary blood vessels to cause emphysema.

“It’s a very well designed study executed to a high technical standard but we need to have some serious reservations about translation to humans”, explained an expert from the University of Melbourne’s Lung Disease Research Group, Professor Gary Anderson, while hailing people to be cautious.

In addition, Professor Anderson claimed that scientists are looking forward to generate a new medication that can be used to improve the health condition of emphysema sufferers. He also emphasized on the need of more research to estimate its impact on humans and notified that mice are blessed with higher capacity for regeneration, unfortunately humans lack this ability.

 

 

Experts express enthusiasm develop drug cure COPD

 

U.S. COPD Coalition's Semi-Annual Business Meeting

Exercise/Pulmonary Rehab and COPD

Exercise/Pulmonary Rehab and the COPD patient

---

Patients with chronic obstructive pulmonary disease often report dyspnea (shortness of breath) on exertion and therefore over time tend to decrease their overall activity. Over time this limitation in activity causes an individual to get short of breath with less activity resulting in an individual becoming less active.

Activity is an important component of one’s everyday life; otherwise individuals will have more symptoms with less and less activity. However starting an exercise program is difficult, especially if one is short of breath with minimal activity as many individuals with chronic obstructive pulmonary disease are. Therefore, many individuals limit their activity because any sort of exertion or activity that increases shortness of breath makes them decrease their activity.

Many individuals with COPD are concerned about starting an exercise program and would benefit greatly from guidance from healthcare professionals. If an individual with COPD is apprehensive about exercise or has extremely limited exercise tolerance, they would benefit greatly from a referral to pulmonary rehabilitation.


see more exercise / COPD info at the lung health professional org

Slide show on the Hemolung br DR Tushar M Chokshi

| View | Upload your own| Email

artificial lung,copd,DR Tushar M Chokshi,hemolung

what is the National Lung Health Education Program ?

what is the National Lung Health Education Program ?

Who We Are —

The National Lung Health Education Program (NLHEP), was initiated in 1996 as a new healthcare initiative designed to increase awareness of Chronic Obstructive Pulmonary Disease (COPD) among the public and health care professionals and to encourage the use of simple spirometry to make an early diagnosis and monitor ongoing treatment.

The NLHEP initiative is directed to primary care physicians, other healthcare clinicians, government officials, policy makers, health care agencies and especially to patients. Many societies, including governmental agencies support NLHEP, and financial support for our organization comes from a wide range of sources, including unrestricted grants from other non-profit organizations, patient advocacy groups, private donors, along with unrestricted grants from the pharmaceutical and medical support industries.

click to see the offical website National Lung Health Education Program

MORE COPD PATIENTS COULD BENEFIT FROM OXYGEN THERAPY

MORE COPD PATIENTS COULD BENEFIT FROM OXYGEN THERAPY

The website 6-minutes, a daily newsletter for Australian doctors, reports on a study that finds many patients ineligible for supplemental oxygen under current criteria could still benefit from oxygen therapy. They conclude that a single daytime measurement of oxygen in the blood may not be the best method of determining who could benefit from oxygen therapy. Researchers find a large number of people are okay during the day, but have oxygen saturations below 90 percent at night. For more information, see:

More COPD patients could benefit from oxygen

Many COPD patients with borderline hypoxaemia would benefit from long term oxygen therapy but are currently excluded due to misleading one-off measurements of oxygenation, Victorian researchers say.

A study of 35 COPD patients with moderate hypoxaemia on resting showed that 24-hour oximetry was able to identify a large subgroup of patients who had clinically significant hypoxaemia throughout the day and especially at night.

The use of ambulatory oximetry showed that 54% of patients spent more than 30% of the monitoring period with oxygen saturation below 90%, “suggesting a significant degree of hypoxaemia that is often missed by point measurement of PaO2,” say the researchers from Barwon Health in the Internal Medicine Journal (online 1 December) .

“We believe this group may include patients with the potential to benefit from this therapy [despite] being ineligible for prescription of long term oxygen therapy according to current criteria,” they write.

The study authors say long term oxygen therapy is known to improve survival, pulmonary dynamics and exercise capacity in patients with severe hypoxaemia, but currently eligibility for oxygen therapy is decided by point measurement of PaO2.

The study also showed that BMI was correlated with daytime hypoxaemia, whereas age and PaO2 were the only significant predictors of nocturnal hypoxaemia.

“Our findings suggest that a single daytime measurement of resting PaO2 may not be the optimal method for determining which patients will benefit from this approach to nocturnal oxygen prescription,” they say.

By Michael Woodhead