Can Genomic Analysis Improve the Diagnostic Yield of Transbronchial Biopsy in the Diagnosis of Usual Interstitial Pneumonia?
Synopsis: Genomic analysis on transbronchial lung biopsy can improve sensitivity in the diagnosis of usual interstitial pneumonia.
Source: Pankratz DG, Choi Y, Imtiaz U, et al. Usual interstitial pneumonia can be detected in trans-bronchial biopsies using machine learning. Ann Am Thorac Soc. 2017;14:1646–1654. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - March 1, 2018 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Are We FULFIL-led by a Once-daily Triple-therapy Inhaler for Chronic Obstructive Pulmonary Disease?
Synopsis: A once-daily triple-therapy inhaler, consisting of a long-acting muscarinic antagonist, a long-acting beta agonist, and an inhaled corticosteroid, resulted in significant improvements in lung function and quality of life in patients with severe chronic obstructive pulmonary disease when compared with a twice-daily dual-therapy inhaler, consisting of a long-acting beta agonist and an inhaled corticosteroid.
Source: Lipson D, Barnacle H, Birk R, et al. FULFIL trial: once-daily triple therapy for patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2017;196(4):438–446. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - March 1, 2018 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Spontaneous Pneumomediastinum: A Rare Case of Bradycardia
Pneumomediastinum is an uncommon phenomenon that may occur in a number of clinical contexts, such as chest trauma, barotrauma, esophageal rupture, or asthma, but it may also occur idiopathically; the latter condition is often referred to as “spontaneous pneumomediastinum” (SPM), formerly as Hamman syndrome. Typically, symptoms associated with SPM are benign, and the condition is self-limited, despite an impressive physical examination largely owing to the presence of subcutaneous emphysema. We illustrate 2 patients who presented with SPM associated with asymptomatic bradycardia, most likely due to the increased stimula...
Source: Clinical Pulmonary Medicine - March 1, 2018 Category: Respiratory Medicine Tags: Images in Pulmonary Medicine Source Type: research
Diagnostic Utility of CD4/CD8 Ratio in Bronchoalveolar Lavage
Accurate and timely identification of pulmonary disease has long been a great challenge in medicine. In most cases, the clinician cannot arrive at a definitive diagnosis via 1 modality alone; thus, multiple tools must be utilized to arrive at the most complete and accurate clinical conclusion. Bronchoalveolar lavage fluid is typically rich in cellular and noncellular constituents of the lower airways, providing insight into the immunologic and inflammatory state of the bronchoalveolar space. Despite the relative ease and safety of obtaining bronchoalveolar lavage fluid, the analysis of specific cell populations remains con...
Source: Clinical Pulmonary Medicine - March 1, 2018 Category: Respiratory Medicine Tags: Clinical Myths and Evidence-Based Medicine Source Type: research
Symmetrical Peripheral Gangrene: Mechanisms for Limb Loss in the ICU in Patients With Retained Pulses
Critically ill patients with shock and disseminated intravascular coagulation (DIC) can develop ischemic limb injury affecting the lower and sometimes the upper extremities. Arterial pulses are usually maintained in symmetrical peripheral gangrene (SPG) as microthrombosis explains injury to acral (distal extremity) tissues. The strikingly symmetrical nature of the tissue injury, affecting 2 or 4 limbs, corresponds to the systemic nature of DIC and diminished peripheral blood flow in shock states. As some patients receive vasopressors, clinicians may attribute limb necrosis to the adverse effects of these agents. However, t...
Source: Clinical Pulmonary Medicine - March 1, 2018 Category: Respiratory Medicine Tags: Topics in Pulmonary Medicine Source Type: research
Sarcoidosis-associated Pulmonary Hypertension: Pathophysiology, Diagnosis, and Treatment
Clinicians in pulmonary medicine frequently confront the challenge of screening, diagnosis, and management of pulmonary hypertension (PH) in sarcoidosis patients who present with unexplained dyspnea. Sarcoidosis-associated pulmonary hypertension (SAPH) is most prevalent in patients with pulmonary fibrosis, although it can be independent of airflow obstruction or restriction. SAPH is independently associated with significantly increased mortality and decreased functional capacity, outcomes that can be mitigated by early detection and focused treatment. In this review, we discuss the pathophysiology of SAPH, which may resemb...
Source: Clinical Pulmonary Medicine - March 1, 2018 Category: Respiratory Medicine Tags: Interstitial, Inflammatory and Occupational Lung Disease Source Type: research
Is it Safe to Extubate Patients Overnight?
Mechanical ventilation can be a life-saving intervention for some critically ill patients, but it is associated with significant complications. Efforts to shorten durations of mechanical ventilation to mitigate against these morbidities, especially in the current climate of heightened staffing of US intensive care units overnight, may make overnight extubation more commonplace. Understanding the safety and effectiveness of this practice is, therefore, of paramount importance. The published literature that informs this issue is limited to 2 retrospective studies published in 2016 with inconsistent findings. In this perspect...
Source: Clinical Pulmonary Medicine - March 1, 2018 Category: Respiratory Medicine Tags: Critical Care/Respiratory Care Source Type: research
Bronchial Thermoplasty: A Review of the Evidence
We present and review the data supporting bronchial thermoplasty—from early feasibility studies to 5-year follow-up trials. In addition, complications, safety, and cost effectiveness are discussed. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - March 1, 2018 Category: Respiratory Medicine Tags: Obstructive Airways Disease Source Type: research
The Liquid Biopsy, What is it, How is it Provided, and What is the Role of the Pulmonologist
Non–small cell lung carcinoma represents the most common form of lung cancer, which itself is the cancer responsible for most deaths annually worldwide. In the advances toward personalized medicine in cancer care, the liquid biopsy is the most recent leap forward allowing treatment based upon driver mutations harbored within a patient. Cell free DNA (cfDNA) is shed from cells within the body, and the tumor cells are no different. This circulating tumor DNA can be sampled and tested for therapeutic and diagnostically actionable genes and gene mutations. Because of the relatively uncommon nature of these circulating tumor ...
Source: Clinical Pulmonary Medicine - March 1, 2018 Category: Respiratory Medicine Tags: Topics in Pulmonary Medicine Source Type: research
Azithromycin for Older, Atopic, Asthmatic Patients with Severe Uncontrolled Disease and a History of Tobacco Use
Synopsis: Prior studies have shown conflicting data for the efficacy of azithromycin for chronic asthma. A study by Gibson and colleagues offers new support for the chronic use of this medication in select populations with uncontrolled disease.
Source: Gibson PG, Yang IA, Upham JW, et al. Effect of azithromycin on asthma exacerbations and quality of life in adults with persistent uncontrolled asthma (AMAZES): a randomized, double-blind, placebo-controlled trial. Lancet 2017;390(10095):659–668. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - January 1, 2018 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
The Administration of Tiotropium in Patients With Early-stage Chronic Obstructive Pulmonary Disease Resulted in Improved Pulmonary Function at 2 Years
Rashid Riaz, MD, Leah Lande, MD, and Dana Zappetti, MD
Synopsis: In this 2-year, multicenter, randomized, double-blind, placebo-controlled trial, the use of tiotropium in patients with chronic obstructive pulmonary disease Global Initiative for Chronic Obstructive Lung Disease stage 1 and stage 2 disease resulted in improved forced expiratory volume in 1 second throughout the trial duration, reduced rate of decline in forced expiratory volume in 1 second after bronchodilator use over 24 months, decreased frequency of exacerbations, and improved quality of life assessments compared with placebo. However, it remains unclear...
Source: Clinical Pulmonary Medicine - January 1, 2018 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Unusual Cause of Left Chest Volume Loss
Volume loss is commonly encountered at chest imaging and may result from a number of causes, including endobronchial obstruction from mucous impaction or centrally obstructing neoplasms, previous surgical resection, and visceral pleural restriction from prior pleural inflammation or intervention. Typically these conditions can be readily distinguished from one another through careful review of the chest radiographic appearance, comparison with prior radiographs, and correlation with appropriate clinical history; occasionally, thoracic computed tomography may be required to clarify chest radiographic findings. When the more...
Source: Clinical Pulmonary Medicine - January 1, 2018 Category: Respiratory Medicine Tags: Images in Pulmonary Medicine Source Type: research
Bronchoscopic Myths and Legends: Is Age a Contraindication to Bronchoscopy?
Given the aging of the US population and the prevalence of lung disease, which warrants diagnostic services in this population, we undertook a survey of pulmonary physicians in order to evaluate their attitudes toward bronchoscopy in the elderly. Specific areas of interest included concerns with regard to comorbidities, preprocedural testing, and perception of procedural complication rates. From November 2013 to January 2014, we surveyed 1896 pulmonary physicians via e-mail about their opinions with regard to bronchoscopy in the elderly. The Survey Monkey service was used to administer the survey. Almost 1900 physicians we...
Source: Clinical Pulmonary Medicine - January 1, 2018 Category: Respiratory Medicine Tags: Clinical Myths and Evidence-Based Medicine Source Type: research
Endotracheal Tube Obstruction Due to Aspirated Foreign Bodies: An Overview of Etiology, Diagnosis, and Management
This report reviews the literature on the previously reported etiologies. In addition, a case vignette is presented as an illustration. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - January 1, 2018 Category: Respiratory Medicine Tags: Critical Care/Respiratory Care Source Type: research
The Role of Rhinovirus in the Pathogenesis and Acute Exacerbation of Asthma
Rhinovirus (RV) is the most common pathogen detected in the nasopharynx of individuals suffering from asthma exacerbation. Experimental data indicate that in addition to its prominent role in acute asthma exacerbation, RV may also serve as an environmental agent driving airway remodeling and bronchial hyperresponsiveness. Understanding the host-pathogen interplay, which results in both acute asthma exacerbation and the instigation of burgeoning disease, may highlight potential avenues for more effective therapeutic interventions. This review summarizes recent data as regards the relationship between RV infection, asthma ex...
Source: Clinical Pulmonary Medicine - January 1, 2018 Category: Respiratory Medicine Tags: Respiratory Infections/Obstructive Airways Disease Source Type: research
