Nonbronchoscopic Methods [Nonbronchoscopic Bronchoalveolar Lavage (BAL), Mini-BAL, Blinded Bronchial Sampling, Blinded Protected Specimen Brush] to Investigate for Pulmonary Infections, Inflammation, and Cellular and Molecular Markers: A Narrative Review
Without reliable diagnostic modalities, determination of the nature of illness can be equivocal, and thus could subject patients to no helpful treatments or unfounded medical interventions and associated financial burdens. Several diagnostic techniques for health care professionals to investigate the possibility of respiratory infection, with emphasis on nonbronchoscopic (NB) methods [nonbronchoscopic bronchoalveolar lavage (NB-BAL), mini-BAL, blinded bronchial sampling, and blinded protected specimen brush], are discussed here. These NB techniques, like bronchoscopic methods, are invasive ways to investigate for lung infe...
Source: Clinical Pulmonary Medicine - January 1, 2017 Category: Respiratory Medicine Tags: Topics in Pulmonary Medicine Source Type: research
Legionella pneumophila: Diagnosis and Management for the Critically Ill and Septic Patient: A Review of the Literature
Legionnaires disease (LD) is caused by a gram-negative aerobic bacterium, Legionella pneumophila, which is an important cause of both community-acquired and nosocomial pneumonia. Although an uncommon pathogen, L. pneumophila is associated with significant morbidity and mortality if left untreated. The clinical manifestations surrounding LD are often unreliable for diagnosis, underlining the importance of the urinary antigen test and cultures of the lower respiratory tract. As a primarily intracellular atypical organism, treatment modalities aimed at penetrating the bacterial cell wall are preferred and include the use of f...
Source: Clinical Pulmonary Medicine - January 1, 2017 Category: Respiratory Medicine Tags: Respiratory Infections Source Type: research
In Acute Right Ventricular Failure, What are the Effects of Preload and Afterload?
The right ventricle (RV) differs from the left ventricle teleologically, in its wall structure, and its function as a low-pressure pump connected to a high-capacitance pulmonary system. Acute RV failure presents differently from left ventricular failure and thus management strategies must also differ. It is well known that preload helps in acute RV failure; however, RV failure can occur from an ischemic RV or from increased RV afterload. We attempt to describe 3 different clinical scenarios leading to RV failure, RV ischemia, acute pulmonary embolism, and pulmonary hypertension, with regard to the effect of preload and aft...
Source: Clinical Pulmonary Medicine - January 1, 2017 Category: Respiratory Medicine Tags: Colleagues in Respiratory Medicine Source Type: research
Do Smokers With Respiratory Symptoms but Preserved Lung Function Have a COPD-like Disease?
Synopsis: There are a subset of smokers with preserved lung function who have respiratory symptoms of cough, sputum production, and shortness of breath. These “symptomatic smokers” have exacerbations, decreased exercise tolerance, and airway thickening on imaging, which suggest COPD despite preserved lung function.
Source: Woodruff P, Barr R, Bleecker E, et al. Clinical significance of symptoms in smokers with preserved pulmonary function. N Engl J Med. 2016;374:1811–1821. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - October 29, 2016 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Is Combination Long-acting Beta-Agonist and Long-acting Muscarinic Antagonist Therapy the Future of COPD Therapy?
Synopsis: A large, randomized, double-blind, multicenter, noninferiority trial revealed consistent superiority in exacerbation reduction, functional respiratory improvement, and quality-of-life indices in certain COPD patients treated with combination long-acting beta-agonist and long-acting muscarinic antagonist when compared with the standard long-acting beta-agonist and inhaled corticosteroid therapy that is commonly prescribed.
Reference: Wedzicha JA, et al. Indacaterol-Glycopyrronium versus Salmeterol-Fluticasone for COPD. N Engl J Med. 2016;374:2222–2234. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - October 29, 2016 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Can the Use of a Genomic Classifier Reduce the Need for Invasive Procedures to Diagnose Lung Cancer?
This study evaluates the potential for a novel genetic classifier in patients with pulmonary nodules to increase the sensitivity and specificity of lung cancer screening and thereby reduce the number of patients being exposed to the harms of invasive diagnostic testing.
Source: Vachani A, Whitney D, Parsons E, et al. Clinical utility of a bronchial genomic classifier in patients with suspected lung cancer. Chest. 2016;150(1):210–218. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - October 29, 2016 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Broncoscopic Myths and Legends: The Use of Fiberoptic Bronchoscopy to Guide Percutaneous Tracheostomy
Percutaneous dilatational tracheostomy can be performed blindly on the basis of the identification of landmarks alone or using fiberoptic bronchoscopy or ultrasonography to guide the procedure. There is controversy regarding the use of bronchoscopic guidance for the procedure. We have evaluated the literature to determine the utility of this practice. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - October 29, 2016 Category: Respiratory Medicine Tags: Clinical Myths & Evidence-Based Medicine Source Type: research
An Unusual Disorder Involving the Central Nervous System and the Thorax
The fact that the thorax is occasionally involved in disorders primarily presenting in extrathoracic locations often prompts screening chest imaging studies for asymptomatic patients. A number of disorders primarily presenting outside the thorax may have subclinical thoracic involvement, including various malignancies and noninfectious inflammatory disorders, such as sarcoidosis and connective tissue diseases. Among the rarest causes for asymptomatic thoracic involvement in the context of a primarily extrathoracic disorder is the Rosai-Dorfman disease. Rosai-Dorfman disease is a rare, nonmalignant polyclonal disorder of hi...
Source: Clinical Pulmonary Medicine - October 29, 2016 Category: Respiratory Medicine Tags: Images in Pulmonary Medicine Source Type: research
Yellow Nail Syndrome: A Review Article
Yellow nail syndrome is a rare clinical syndrome characterized by a triad of yellow dystrophic nails, lymphedema, and respiratory manifestations. These include chronic cough with sputum production, recurrent respiratory infections, pleural effusions, bronchiectasis, and rhinosinusitis. This paper reviews the literature on this rare condition, aiming to increase awareness of this disease to allow better diagnosis, management, and patient outcomes. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - October 29, 2016 Category: Respiratory Medicine Tags: Topics in Pulmonary Medicine Source Type: research
Modern Management of Malignant Pleural Effusions
The development of a malignant pleural effusion (MPE) is diagnostic of advanced incurable cancer, and is seen with increasing frequency as the population ages and patients with malignancy survive for longer after the diagnosis as a result of advances in oncological therapies. MPE is frequently associated with significant symptoms including dyspnea, malaise, and cough that have a negative impact on a patient’s quality of life. Treatment is generally palliative, with the median survival after diagnosis varying from 3 to 12 months. There has been considerable progress in recent years with respect to the management of MPE, a...
Source: Clinical Pulmonary Medicine - October 29, 2016 Category: Respiratory Medicine Tags: Topics in Pulmonary Medicine Source Type: research
Inhaled Mannitol in the Diagnosis and the Management of Asthma
The need for a diagnostic test for asthma was established when it was realized that asthma symptoms could not be relied upon to predict the presence, or not, of airway hyper-responsiveness and inflammation, the hallmarks of asthma. A need to identify asthmatic patients who were overtreated or undertreated with inhaled corticosteroids (ICS) has also been recognized. Dry-powder mannitol, given by inhalation, is used as a bronchial provocation test to meet this need. Mannitol is an osmotic agent and causes the release of mediators that provoke the airways to narrow. This airway response to mannitol is dependent on the presenc...
Source: Clinical Pulmonary Medicine - October 29, 2016 Category: Respiratory Medicine Tags: Obstructive Airways Disease Source Type: research
Outcomes of Mechanically Ventilated Liver Failure Patients Admitted to the Intensive Care Unit
Conclusions: The in-hospital mortality remains as high at 54%. The MELD score was consistently a predictor for overall, in-hospital, and postdischarge mortalities. Patients readmitted to the ICU were 4 times more likely to die in 1 year. Most survivors who were liver transplant candidates died waiting for an organ. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - October 29, 2016 Category: Respiratory Medicine Tags: Critical Care/Respiratory Care Source Type: research
New Treatments for Idiopathic Pulmonary Fibrosis
Idiopathic pulmonary fibrosis (IPF) is a progressive disease that kills nearly 40,000 US citizens annually and has a median survival that has been estimated at 3 to 5 years. Most placebo-controlled, randomized clinical trials performed with promising new therapies over the past 15 years have not achieved chosen therapeutic endpoints, but multiple Phase 3 trials with 2 agents, pirfenidone and nintedanib, demonstrated a significant slowing of the forced vital capacity decrease, and these antifibrotic drugs were recently approved by the US Food & Drug Administration as of October 2014 for prescription in the United States. Th...
Source: Clinical Pulmonary Medicine - October 29, 2016 Category: Respiratory Medicine Tags: Interstitial, Inflammatory, & Occupational Lung Disease Source Type: research
The Safety of Fluticasone-Salmeterol in Patients With Moderate to Severe Asthma
Synopsis: The AUSTRi trial evaluated the safety of combination fluticisone-salmeterol in moderate to severe asthma, and this medication was found to be noninferior to fluticasone alone. This is an important first study in validating the use of this medication in asthmatic patients after earlier controversial studies suggested the risk of routinely adding long-acting β-agonists to the management of asthma patients.
Source: Stempel, DA, Raphiou IH, Kral KM, et al. Serious asthma events with fluticasone plus salmeterol versus fluticasone alone. N Engl J Med. 2016;374(19):1822–1830. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - August 27, 2016 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Treatment of Mycobacterium avium Complex Lung Disease With Clofazimine
Synopsis: Mycobacterium avium and Mycobacterium intracellulare, collectively known as the M. avium complex, are the most common causes of nontuberculous mycobaterial lung disease. Treatment of M. avium complex lung disease is challenging, as it requires patients to adhere to a multidrug regimen that is notorious for adverse drug effects. In this retrospective study by Jarand et al, clofazimine-containing regimens exhibited higher sputum conversion rates than rifampin-containing regimens. Rates of microbiologic relapse and retreatment were similar between the 2 groups.
Source: Jarand J, Davis JP, Cowie RL, et al. Long-term...
Source: Clinical Pulmonary Medicine - August 27, 2016 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
