Nontraumatic Tracheal Injuries in Adults: A Case Report and Review of the Literature
Tracheal injuries not caused by trauma are uncommon, and are usually related to endobronchial procedures, including intubation, and thoracic surgery. The clinical consequences of tracheal injuries can be minimal or life threatening, depending on the extent of injury and time to recognition. Management of nontraumatic tracheal injuries is uncertain, and it ranges from watchful waiting, to endobronchial intervention, to surgical management. A representative case is presented in which a tracheal laceration failed surgical repair, precipitated a pneumothorax, and required endobronchial administration of fibrin glue and 2-octyl...
Source: Clinical Pulmonary Medicine - January 1, 2018 Category: Respiratory Medicine Tags: Topics in Pulmonary Medicine Source Type: research
A Review of Long-term Oxygen Therapy in Chronic Obstructive Pulmonary Disease
Supplemental oxygen is a time-honored therapy for patients with chronic obstructive pulmonary disease (COPD), with varying indications. Classic studies demonstrate the benefit of supplemental oxygen in COPD patients with resting hypoxemia used as close to 24 hours daily as possible. Yet, the role of supplemental oxygen in other clinical contexts for these patients (eg, mild resting hypoxemia, desaturation with activity only, or nocturnal desaturation) is less clear. The current paper reviews the evidence with regard to the use of supplemental oxygen for patients with COPD in these various settings. Recently, the Long-term ...
Source: Clinical Pulmonary Medicine - January 1, 2018 Category: Respiratory Medicine Tags: Obstructive Airways Disease 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
Nontraumatic Tracheal Injuries in Adults: A Case Report and Review of the Literature
Tracheal injuries not caused by trauma are uncommon, and are usually related to endobronchial procedures, including intubation, and thoracic surgery. The clinical consequences of tracheal injuries can be minimal or life threatening, depending on the extent of injury and time to recognition. Management of nontraumatic tracheal injuries is uncertain, and it ranges from watchful waiting, to endobronchial intervention, to surgical management. A representative case is presented in which a tracheal laceration failed surgical repair, precipitated a pneumothorax, and required endobronchial administration of fibrin glue and 2-octyl...
Source: Clinical Pulmonary Medicine - January 1, 2018 Category: Respiratory Medicine Tags: Topics in Pulmonary Medicine Source Type: research
A Review of Long-term Oxygen Therapy in Chronic Obstructive Pulmonary Disease
Supplemental oxygen is a time-honored therapy for patients with chronic obstructive pulmonary disease (COPD), with varying indications. Classic studies demonstrate the benefit of supplemental oxygen in COPD patients with resting hypoxemia used as close to 24 hours daily as possible. Yet, the role of supplemental oxygen in other clinical contexts for these patients (eg, mild resting hypoxemia, desaturation with activity only, or nocturnal desaturation) is less clear. The current paper reviews the evidence with regard to the use of supplemental oxygen for patients with COPD in these various settings. Recently, the Long-term ...
Source: Clinical Pulmonary Medicine - January 1, 2018 Category: Respiratory Medicine Tags: Obstructive Airways Disease Source Type: research
Atorvastatin in the Treatment of Bronchiectasis and Pseduomonas aeruginosa Colonization
Synopsis: This proof of concept study showed a reduction in systemic inflammation and an improved quality of life for patients with bronchiectasis and chronic Pseudomonas aeruginosa infection.
Source: Bedi P, Chalmers JD, Graham C, et al. A randomized control trial of atorvastatin in patients with bronchiectasis infected with Pseudomonas aeruginosa: a proof of concept study. Chest. 2017;152(2):368–378. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - November 1, 2017 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Is Anti-IL 5 Therapy Effective in Eosinophilic Granulomatosis With Polyangiitis?
Synopsis: In patients with EGPA who are glucocorticoid dependent, use of mepolizumab decreased the use of glucocorticoids and increased rates of remission compared with placebo.
Source: Wechsler ME, Akuthota P, Jayne D, et al. Mepolizumab or placebo for eosinophilic granulomatosis with polyangiitis. N Engl J Med 2017; 376:1921–932. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - November 1, 2017 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Multiple Nodules and Masses: An Unusual Etiology
Pulmonary nodules are a common abnormality detected at chest radiography, and even more so with thoracic computed tomography. Multiple pulmonary nodules are most commonly the result of previous granulomatous infection or metastatic disease. Less commonly, multiple pulmonary nodules may be the result of lymphoproliferative disorders and other rare conditions, such as rheumatoid lung nodules and amyloidosis. Pulmonary hyalinizing granuloma (PHG) is a very rare lesion that may be associated with an immunologic or postinfectious trigger. This disorder shows dense networks of hyalinized collagen bundles concentrically arranged ...
Source: Clinical Pulmonary Medicine - November 1, 2017 Category: Respiratory Medicine Tags: Images in Pulmonary Medicine Source Type: research
Has Mortality of Community-Acquired Pneumonia Really Reduced?
Community-acquired pneumonia is a major health problem associated with high morbidity and mortality, and hospital admissions for pneumonia seem to be increasing. Whether mortality is currently decreasing is controversial and is influenced by several factors: aging population and increase in comorbidities, microbiological and antibiotic changes, management improvements in intensive care units, pneumococcal and influenza vaccines, and immunomodulatory treatments. Despite the heterogeneity of data, in the last few years, some important articles have been published, suggesting a progressive decline in mortality despite an upwa...
Source: Clinical Pulmonary Medicine - November 1, 2017 Category: Respiratory Medicine Tags: Respiratory Infections Source Type: research
Monoclonal Antibody Therapy for Asthma
Asthma is characterized by airway inflammation and reversible airflow limitation. Severe asthma accounts for 5% to 10% of asthmatic patients but more than half of the cost of asthma care in the United States. There is increasing interest in characterizing and managing this difficult population. The mainstay of asthma treatment is the use of inhaled corticosteroids and bronchodilators, although in patients with severe asthma, many rely on systemic glucocorticoids for asthma control. Newer monoclonal antibodies are providing an alternative to systemic glucocorticoids for asthma control and exacerbation prevention. The first ...
Source: Clinical Pulmonary Medicine - November 1, 2017 Category: Respiratory Medicine Tags: Obstructive Airways Disease Source Type: research
