Risk Factors for Community-acquired Pneumonia in Adults: A Review
We present a review of the main risk factors for CAP in adults, paying particular attention to chronic comorbidities, medication, and lifestyle factors. The most frequently observed comorbidities associated with CAP are chronic obstructive pulmonary disease, asthma, and heart failure. Certain lifestyle factors such as smoking, dental hygiene, nutritional and dietary habits, and certain working and environmental conditions (such as contact with dust and sudden changes of temperature) have been shown to be modifiable risk factors for CAP. Moreover, in the elderly, oropharyngeal dysphagia is a major risk factor for CAP, as an...
Source: Clinical Pulmonary Medicine - May 1, 2016 Category: Respiratory Medicine Tags: Respiratory Infections Source Type: research
Discontinuation of Inhaled Corticosteroids May Reduce the Risk of Pneumonia in COPD Patients
Synopsis: The use of inhaled corticosteroids is recommended for the treatment of COPD, but there is the question of whether this medication predisposes one to an increased risk of bacterial pneumonia. This large-cohort study attempts to better define whether the discontinuation of inhaled corticosteroids can decrease the risk of serious pneumonia.
Source: Suissa S, Coulombe J, Ernst. Discontinuation of inhaled corticosteroids in COPD and the risk reduction of pneumonia. Chest. 2015; 148(5):1177–1183. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - February 27, 2016 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Some Isolated Subsegmental Pulmonary Artery Defects Seen on Pulmonary CT Angiography May Not Represent True Pulmonary Embolism
Synopsis: Pulmonary computed tomographic angiography has overtaken all other diagnostic modalities to detect pulmonary embolism due to its high sensitivity, widespread availability, and rapid image acquisition. In some cases, isolated subsegmental defects are identified as pulmonary embolism. A fraction of these studies may be interpreted as negative when reviewed by expert thoracic radiologists, questioning the diagnostic accuracy of computed tomographic angiography for these small single defects. Furthermore, the clinical significance of these isolated subsegmental defects remains unclear.
Source: Hutchinson BD, Navin P...
Source: Clinical Pulmonary Medicine - February 27, 2016 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
A Lifestyle Modification Program Associated With Weight Loss Reduces the Severity of OSA
Synopsis: Obesity is a major risk factor for OSA. The study by Ng and colleagues assessed the impact of weight loss reduction through a lifestyle modification program on patients with moderate to severe OSA. They found a reduction in OSA severity and daytime sleepiness that was directly associated with weight loss.
Source: Ng SS, Chan RS, Woo J, Chan TO, Cheung BH, Sea MM, To KW, Chan KK, Ngai J, Yip WH, Ko FW, Hui DS. A randomized controlled study to examine the effect of a lifestyle modification program in OSA. Chest. 2015; 148(5):1193–1203. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - February 27, 2016 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
An Unusual Intrathoracic Mass in a Patient With Developmental Delay
This report highlights the differential diagnoses that were considered for this mediastinal mass and the diagnostic evaluation that led to the final diagnosis. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - February 27, 2016 Category: Respiratory Medicine Tags: Images in Pulmonary Medicine Source Type: research
Negative Predictive Value of Endobronchial Ultrasound–guided Transbronchial Needle Aspiration
Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration is now the standard care for minimally invasive staging of the mediastinum. A literature review of EBUS was performed in its use for diagnosing and staging lung cancer and for staging extrathoracic malignancies. We evaluated the negative predictive value of EBUS in varying diagnostic scenarios. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - February 27, 2016 Category: Respiratory Medicine Tags: Topics in Pulmonary Medicine Source Type: research
Life-saving Inhaled Sevoflurane Administered to an Adult With Severe Bronchospasm Secondary to COPD Exacerbation
We present the case of a 60-year-old man who was admitted with severe COPD exacerbation, with critical bronchospasm that required mechanical ventilation after failed conventional therapies. This patient received oxygen, inhaled β-agonists and anticholingerics, intravenous corticosteroids, and macrolide antibiotics. He then required mechanical ventilation with administration of magnesium, ketamine, and inhaled heliox for his bronchospasm, with no improvement. Ultimately, he was treated successfully with an inhaled anesthetic, sevoflurane, as salvage therapy. Success was measured by decreasing peak and plateau airway pressu...
Source: Clinical Pulmonary Medicine - February 27, 2016 Category: Respiratory Medicine Tags: Obstructive Airways Disease Source Type: research
Pulmonary Alveolar Proteinosis: Pathogenesis, Diagnosis, and Management
Pulmonary alveolar proteinosis (PAP) is an uncommon respiratory disorder caused by an increase in surfactant accumulation in the distal airspaces of the lung. It is a common endpoint of several derangements of the homeostatic mechanisms regulating surfactant metabolism. In adults, the majority of the cases of PAP are of autoimmune etiology and result from an increase in the production of autoantibodies to the cytokine granulocyte-macrophage colony-stimulating factor (GM-CSF). Less commonly, PAP develops in association with other conditions or is caused by genetic mutations that either disrupt GM-CSF signaling or alter othe...
Source: Clinical Pulmonary Medicine - February 27, 2016 Category: Respiratory Medicine Tags: Interstitial, Inflammatory, & Occupational Lung Disease Source Type: research
Refractory Pulmonary Sarcoidosis: Proposal of a Definition and Recommendations for the Diagnostic and Therapeutic Approach
Patients with sarcoidosis undergo spontaneous remission or may be effectively controlled with glucocorticoids alone in many cases. Progressive and refractory pulmonary sarcoidoisis constitute >10% of the patients seen at specialized centers. Pulmonary fibrosis and associated complications, such as infections and pulmonary hypertension, are leading causes of mortality. No universal definition of refractoriness exists; we therefore propose classifying patients as having refractory disease when the following criteria are fulfilled: (1) progressive disease despite at least 10 mg of prednisolone or equivalent for at least 3 mon...
Source: Clinical Pulmonary Medicine - February 27, 2016 Category: Respiratory Medicine Tags: Interstitial, Inflammatory, & Occupational Lung Disease Source Type: research
Understanding Persistent Bacterial Lung Infections: Clinical Implications Informed by the Biology of the Microbiota and Biofilms
The infections found in chronic obstructive pulmonary disease, cystic fibrosis, and bronchiectasis share a number of clinical similarities, the most striking of which is the bacterial persistence despite the use of antibiotics. These infections have been clinically described using culture-based methods usually performed on sputum samples, and treatment has been directed toward the bacteria found in this manner. Unfortunately, the clinical response to antibiotics is frequently not predictable on the basis of these cultures, and the role of these cultured organisms in disease progression has been debated. The past 20 years h...
Source: Clinical Pulmonary Medicine - February 27, 2016 Category: Respiratory Medicine Tags: Respiratory Infections Source Type: research
Use of Flexible Bronchoscopy in the Diagnosis of Infectious Etiologies: A Literature Review
Flexible bronchoscopy is a common tool utilized to assist physicians in the diagnosis of suspected infectious disease of the pulmonary system. This manuscript reviews the utility of bronchoscopy for the management of infectious conditions. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - December 22, 2015 Category: Respiratory Medicine Tags: Clinical Myths and Evidence-Based Medicine Source Type: research
A Calcified Mass Within the Thorax: An Unusual Diagnosis
Inflammatory myofibroblastic tumor (IMT) is a rare proliferative lesion also referred to as an inflammatory pseudotumor, among a number of other pseudonyms. IMTs are comprised of variable amounts of spindle cells, collagen, and inflammatory cells, including plasma cells, foamy histiocytes, and lymphocytes. IMTs may affect different organ systems, but the thorax is the most commonly affected, particularly the lung or the airways, and less commonly the mediastinum. IMTs exhibit a variable biological behavior, ranging from spontaneous involution to locally aggressive behavior, including recurrence after resection, regional ex...
Source: Clinical Pulmonary Medicine - December 22, 2015 Category: Respiratory Medicine Tags: Images in Pulmonary Medicine Source Type: research
Combination Therapy as the First-Line Treatment for Pulmonary Arterial Hypertension
Synopsis: The AMBITION trial compared upfront combination therapy with tadalafil and ambrisentan, with each drug analyzed individually in treatment-naive WHO functional group II-III pulmonary arterial hypertension patients. Statistically significant improvements were seen in the mortality, hospitalization for worsening pulmonary hypertension, disease progression, and the clinical response.
Source: Galie N, Barbera JA, Frost AE, et al. Initial use of ambrisentan plus tadalafil in pulmonary arterial hypertension. N Engl J Med. 2015;373(9):834-844. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - December 22, 2015 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Is There an Ideal Site for Central Venous Catheterization?
Synopsis: In a head-to-head trial investigating the ideal site for central venous catheterization, subclavian vein cannulation resulted in less infection and deep-vein thrombosis, but was associated with more mechanical complications than catherization of the femoral or the jugular veins.
Source: Parienti JJ, Mongardon N, Mégarbane B, et al. Intravascular complications of central venous catheterization by insertion site. N Engl J Med. 2015; 373(13): 1220–1229. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - December 22, 2015 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Pneumocystis jirovecii: A Fresh Look
Pneumocystis pneumonia (PCP) cases have become commonplace due to both HIV/AIDS and an increase in the therapeutically immunosuppressed population. Pneumocystis species are mammalian host specific, and rather than an environmental reservoir, it is now believed that it is children with asymptomatic infection who harbor and transmit the disease. PCP has an insidious onset, usually presenting with dry cough, fever, and dyspnea. On examination, patients will mostly have clear chests, in stark comparison with their breathlessness and bilateral infiltrates on chest x-ray. Diagnosis can be a challenge and a high level of suspicio...
Source: Clinical Pulmonary Medicine - December 22, 2015 Category: Respiratory Medicine Tags: Topics in Pulmonary Medicine Source Type: research
