A 38-Year-Old Woman With Progressive Shortness of Breath
A 38-year-old woman presented with dyspnea and fever of 15 days’ duration accompanied by dysphagia and loss of weight. Clinical examination revealed tachypnea and bibasilar fine crepitations. Blood gases showed hypoxemia. Chest radiography showed hazy increased lung opacity and coarse lung markings symmetrically involving the lung bases. High-resolution computed tomography of the lung showed patchy subpleural foci of ground glass attenuation bilaterally in the upper lobes. In the lower lobes, there was evidence of peripheral peribronchial bibasilar consolidation, which was more extensive on the left side and associated w...
Source: Clinical Pulmonary Medicine - June 30, 2017 Category: Respiratory Medicine Tags: Respiratory Infections/Images in Pulmonary Medicine Source Type: research
COPD: Recent Updates and Role of Chronic Disease Management and Protocolized Management
The annual cost of chronic obstructive pulmonary disease (COPD) in the United States in 2008 was $53.7 billion, largely due to visits to a medical facility for exacerbations. In this article, we explore the most recent updates on the medical management of COPD, including the most recently released inhalers. We also explore the role of COPD self-management and integrated disease management, and discuss the most recent studies pertaining to those. In addition, we discuss the most recent updates on bronchoscopic interventions for lung volume reduction. We also discuss the results of our study assessing the role of protocolize...
Source: Clinical Pulmonary Medicine - June 30, 2017 Category: Respiratory Medicine Tags: Clinical Practice Management/Obstructive Airways Disease Source Type: research
Precision-guided, Personalized Intrapleural Fibrinolytic Therapy for Empyema and Complicated Parapneumonic Pleural Effusions: The Case for The Fibrinolytic Potential
Complicated pleural effusions and empyema with loculation and failed drainage are common clinical problems. In adults, intrapleural fibrinolytic therapy (IPFT) is commonly used with variable results, and therapy remains empiric. Despite the intrapleural use of various plasminogen activators (PAs)—fibrinolysins—for about 60 years, there is no clear consensus about which agent is most effective. Emerging evidence demonstrates that intrapleural administration of PAs is subject to rapid inhibition by PA inhibitor-1 and that processing of fibrinolysins is significantly influenced by other factors, including the levels and q...
Source: Clinical Pulmonary Medicine - June 30, 2017 Category: Respiratory Medicine Tags: Topics in Pulmonary Medicine Source Type: research
Successful Endobronchial Resection of Obstructive Inflammatory Myofibroblastic Airway Tumor With Anaplastic Lymphoma Kinase (ALK) Positivity
This report describes the effective endobronchial treatment of an inflammatory myofibroblastic tumors causing left mainstem airway obstruction without regional extension or distant metastases. Although surgical interventions such as sleeve resection or complete pneumonectomy may be effective therapeutic options for parenchymal tumors, endobronchial therapy, with an understanding of anaplastic lymphoma kinase status, may offer an equally effective lung-sparing treatment option. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - June 30, 2017 Category: Respiratory Medicine Tags: Interventional Pulmonary Medicine Source Type: research
A Mixed Treatment Comparison Meta-Analysis of Pharmacotherapeutic Monotherapy and Placebo for Pulmonary Artery Hypertension
Pulmonary artery hypertension (PAH) is rare, progressive, and difficult to treat. Earlier trials have found that active drug treatments improve hemodynamics, surrogate outcomes, and mortality compared with placebo. Few direct trials of active treatments exist and a mixed treatment comparison network meta-analysis allows comparisons of direct and indirect treatment effects. Randomized controlled trials of patients aged 10 to 80 years with idiopathic or secondary PAH treated with epoprostenol, treprostinil, iloprost, beraprost, bosentan, ambrisentan, macitentan, sildenafil, tadalafil, vardenafil, or riociguat monotherapy wer...
Source: Clinical Pulmonary Medicine - June 30, 2017 Category: Respiratory Medicine Tags: Topics in Pulmonary Medicine Source Type: research
Should We Regularly Include Pulmonary Embolism in the Differential Diagnosis of Syncope?
Synopsis: In patients admitted to the hospital for a first episode of syncope, workup for pulmonary embolism should be included, despite alternative explanations for the syncopal episode. Pulmonary embolism was identified in nearly 1 of every 6 patients hospitalized for syncope.
Source: Prandoni P, Lensing AW, Prins MH, et al. Prevalence of pulmonary embolism among patients hospitalized for syncope. N Engl J Med. 2016;375:1524–1531. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - May 1, 2017 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Noninvasive Ventilation With a Helmet Interface May Be More Effective Than a Traditional Facemask for Preventing Endotracheal Intubation in Patients With Acute Respiratory Distress Syndrome
Synopsis: A total of 83 patients with acute respiratory distress syndrome requiring at least 8 hours of noninvasive ventilation were randomized to continue noninvasive ventilation using a traditional facemask interface or changed to a helmet interface. Subjects in the helmet group had lower rates of intubation (18.2 vs. 61.5%; P (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - May 1, 2017 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Clinical Myths and Legends: Balloon Bronchoplasty for Benign Diseases of the Airway
Although interventional bronchoscopy is widely used in the management of malignant airway obstruction, less is understood about its role in airway stenosis secondary to benign diseases. The present discussion briefly reviews the application of balloon dilation in the context of infectious, inflammatory, and post–lung-transplant tracheobronchial stenosis. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - May 1, 2017 Category: Respiratory Medicine Tags: Clinical Myths and Evidence-Based Medicine Source Type: research
A “Hole” New World: Empyema Necessitans From Mycobacterium kansasii
Empyema necessitans (pleurocutaneous fistula) is a rarely seen late complication of empyema thoracis. It is typically associated with Mycobacterium tuberculosis and Actinomyces spp., aggressive pathogens capable of dissecting through tissue planes. However, this entity may occasionally occur late in the course of infection with more indolent organisms. Cases due to coccidioidomycosis, mucormycosis, and aspergillosis have all been described. Only 3 cases of empyema necessitans due to nontuberculous mycobacteria have been reported in the literature and no cases have been reported in association with Mycobacterium kansasii. I...
Source: Clinical Pulmonary Medicine - May 1, 2017 Category: Respiratory Medicine Tags: Images in Pulmonary Medicine Source Type: research
Lung Cancer Screening in Patients With Chronic Obstructive Pulmonary Disease
Results from the National Lung Screening Trial (NLST) showed that annual lung cancer screening with low-dose computed tomography reduces lung cancer–related mortality. On the basis of NLST selection criteria, major health organizations have made recommendations regarding the population who should be offered lung cancer screening. Although chronic obstructive pulmonary disease (COPD) is an independent risk factor for lung cancer, most organizations do not include this specifically as part of their eligibility criteria for screening. This review aims to summarize the epidemiologic evidence connecting airflow obstruction an...
Source: Clinical Pulmonary Medicine - May 1, 2017 Category: Respiratory Medicine Tags: Obstructive Airways Disease Source Type: research
Relevance of Chest Ultrasound in Mechanically Ventilated Patients
Bedside ultrasonography can be very useful in the evaluation and management of mechanically ventilated patients. In intensive care units the role of ultrasound is not limited to diagnosis but can be used as a guide for management of mechanical ventilation from early stages to weaning. To obtain a comprehensive functional evaluation of critical care patients during mechanical ventilation, chest ultrasonography should include the examinations of the lungs, heart, and diaphragm. Lung ultrasound is an emerging and increasingly used imaging tool to investigate both in a semiquantitative and quantitative way lung aeration during...
Source: Clinical Pulmonary Medicine - May 1, 2017 Category: Respiratory Medicine Tags: Topics in Pulmonary Medicine Source Type: research
What We Learned From the EU-VAP/CAP Study for Severe Pneumonia
EU-VAP/CAP is the largest observational, multicenter, international study conducted in Europe, focusing on severe pneumonia in the intensive care unit. It provided important insights into the different aspects of diagnostics and management of severe community-acquired pneumonia (CAP) and nosocomial pneumonia. Incidence, specificities of early-onset and late-onset settings, microbiologic etiology, antimicrobial prescription, and outcomes were analyzed, with a closer look at ventilator-associated pneumonia (VAP). Distinct populations showing specific risk factors, and outcomes were set (trauma VAP, elderly VAP, chronic obstr...
Source: Clinical Pulmonary Medicine - May 1, 2017 Category: Respiratory Medicine Tags: Respiratory Infections Source Type: research
Providing Palliative Care for Patients With Lung Cancer
Palliative care (PC) focuses on improving the quality of life and minimizing suffering in patients with chronic, symptomatic, and life-threatening disease. Because of severe and progressive symptoms, coexisting lung disease, anxiety, and depression, lung cancer (LC) patients derive robust benefit from PC. Multiple studies have shown that PC in LC improves quality of life, survival, mental health outcomes, and caregiver satisfaction. Despite proven benefit, PC is very often viewed as a therapy of last resort, and opportunities to reduce suffering are missed. To be most effective, PC should be provided by generalists and spe...
Source: Clinical Pulmonary Medicine - May 1, 2017 Category: Respiratory Medicine Tags: Colleagues in Respiratory Medicine Source Type: research
High-Flow Nasal Cannula Therapy in Adults
Oxygen is the first-line therapy for hypoxemic respiratory failure and is usually delivered through nasal cannulae or a face mask. More recently, there has been increased interest in the use of high-flow nasal cannula (HFNC) oxygen therapy, in which optimally heated and humidified oxygen is delivered at high flow rates of up to 60 L/min. HFNC therapy has a number of advantages over traditional, low-flow oxygen therapy: provision of low-level positive-end expiratory pressure, flushing of anatomical dead space, provision of higher and more predictable fraction of inspired oxygen and enhanced patient tolerance and compliance....
Source: Clinical Pulmonary Medicine - May 1, 2017 Category: Respiratory Medicine Tags: Critical Care/Respiratory Care Source Type: research
Less is More: Do Patients With COPD and Moderate Resting or Exercise-induced Desaturation Benefit From Long-term Supplemental Oxygen Therapy?
Synopsis: Although long-term supplemental oxygen for patients with COPD and severe resting oxygen desaturation is associated with reduced mortality, it has remained unclear whether patients with moderate desaturation would derive a similar benefit. This large, randomized clinical trial demonstrated that long-term supplemental oxygen in patients with moderate resting or exercise-induced desaturations has neither reduced time to mortality nor time to first hospitalization for any cause. Furthermore, it provided no reduction in the incidence of COPD exacerbations and no improvement in lung function, quality of life, or functi...
Source: Clinical Pulmonary Medicine - March 1, 2017 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
