Antibiotic Use and Stewardship in Cystic Fibrosis: A Review for Noncystic Fibrosis Providers
Antibiotics form the foundation of comprehensive cystic fibrosis (CF) therapy and are responsible for invaluable gains in life expectancy and quality of life. Although antibiotic stewardship may be perceived to be in conflict with appropriate CF care, there are many potential benefits to antibiotic stewardship in CF. Antimicrobial stewardship teams can provide a collaborative approach to CF care and provide assistance with antibiotic selection, therapeutic drug monitoring, and recommendation of best practices supported by evidenced-based guidelines. The aim of this review is to introduce the rationale for the use of antibi...
Source: Clinical Pulmonary Medicine - September 1, 2020 Category: Respiratory Medicine Tags: Topics in Pulmonary Medicine Source Type: research
The Association Between Pneumonia and Heart failure
Heart failure (HF) may be associated with pneumonia as HF is one of the most common complications of patients who have a primary diagnosis of pneumonia. Patients who develop HF from pneumonia are associated with higher severity of pneumonia and higher mortality rate. The purpose of this review was to summarize the association between pneumonia and HF with the available literature and discuss the pathophysiology underlying it. Ten studies have been included in this review to support the association between pneumonia and HF. Awareness of this association is essential for clinical management and to improve the outcomes of the...
Source: Clinical Pulmonary Medicine - September 1, 2020 Category: Respiratory Medicine Tags: Respiratory Infections Source Type: research
Should Every Patient Admitted for a Community-acquired Pneumonia Get Blood Cultures to Detect Bacteremia?
Synopsis: This retrospective analysis identified the proportion of patients with afebrile bacteremia when admitted for community-acquired pneumonia (CAP) and investigated negative and positive predictors of bacteremia in afebrile CAP patients. A significant proportion of afebrile patients admitted for CAP was bacteremic and had increased mortality when compared with febrile bacteremic patients or nonfebrile nonbacteremic patients. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - July 1, 2020 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
A SuStaIn-able Approach to Modeling COPD Progression?
Synopsis: Analysis of imaging characteristics in smokers with COPD compared with smoking controls identified 2 distinct COPD subtypes and correlated disease stage with degree of spirometric impairment and timing of functional decline. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - July 1, 2020 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Déjà Vu All Over Again
In late 2019, an acute, severe lower respiratory tract illness of unknown etiology, linked to contact with a live seafood and animal market, was reported in Wuhan City, Hubei Province, China, subsequently shown to be caused by a novel coronavirus termed the Severe Acute Respiratory Syndrome (SARS) Coronavirus (CoV)-2. The infection caused by this virus is referred to as coronavirus disease 2019, or COVID-19. SARS-CoV-2 infects human cells through binding of viral surface spike protein to human angiotensin-converting enzyme 2 receptors, predominantly expressed on Type II alveolar cells, in the lung. SARS-CoV-2 is highly tra...
Source: Clinical Pulmonary Medicine - July 1, 2020 Category: Respiratory Medicine Tags: Images in Pulmonary Medicine Source Type: research
The Safety and Feasibility of Endobronchial Ultrasound Bronchoscopy–guided Intranodal Forceps Biopsies (EBUS-INF)
This study suggests that EBUS-INF is an effective and safe method for the sampling of mediastinal and/or hilar lymph nodes when performed in conjunction with EBUS-TBNA. There is a trend toward higher likelihood of a diagnosis of granulomatous disease or lymphoma when EBUS-INF is used compared with EBUS-TBNA alone. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - July 1, 2020 Category: Respiratory Medicine Tags: Interventional Pulmonary Medicine Source Type: research
Best Evidence Topic: Does the Depth of Sedation Affect Diagnostic Yield of Endobronchial Ultrasound–guided Transbronchial Needle Aspiration?
The ideal type of sedation during endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA) is still a matter of debate. We evaluated whether depth of sedation could affect the EBUS-TBNA results. We reviewed the literature until February 2020, and 11 studies (7 retrospective; 2 prospective observational; and 2 randomized controlled) provided the most applicable evidence to answer the question. All studies but one found that the depth of sedation did not affect diagnostic yield. Eight papers counted the number of lesions sampled per patient, and all studies but 1 found higher number of lesions biopsied ...
Source: Clinical Pulmonary Medicine - July 1, 2020 Category: Respiratory Medicine Tags: Interventional Pulmonary Medicine Source Type: research
Meta-analysis: COVID-19 Disease Severity Correlates With Smoking Status
The novel Coronavirus Disease 2019 (COVID-19) disease is a contagious acute respiratory infectious disease whose causative agent has been demonstrated to be a new virus of the coronavirus family, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Multiple studies have already reported that risk factors for severe disease include older age and the presence of at least one of several underlying health conditions. However, a recent physiopathologic report and the French COVID-19 scientific council have postulated a protective effect of tobacco smoking. Thanks to a meta-analysis, we have been able to demonstrate the...
Source: Clinical Pulmonary Medicine - July 1, 2020 Category: Respiratory Medicine Tags: Respiratory Infections Source Type: research
Evaluation of Knowledge and Skills of Patients With Asthma and COPD in Using Inhaled Therapy
This study aimed to evaluate knowledge and skills in the use of inhaler devices in patients with asthma and chronic obstructive pulmonary disease who presented to our clinic for the first time. The patients were enrolled in the study by a pulmonologist. All patients were asked to demonstrate how they used their inhaler device and were assigned scores for their performance. A total of 108 patients were enrolled in the study. Discus (36.1%) and Aerolizer (31.5%) were the most commonly used devices. Patients of both sexes made more errors in the 2 steps of inhaler use (putting the device into the mouth and holding breath afte...
Source: Clinical Pulmonary Medicine - July 1, 2020 Category: Respiratory Medicine Tags: Obstructive Airways Disease Source Type: research
Clinical and Laboratory Findings on the Differences Between H1N1 Influenza and Coronavirus Disease-2019 (COVID-19): Focusing on the Treatment Approach
In this study, therefore, we compared some clinical, demographic, and laboratory findings to determine the differences between H1N1 influenza and coronavirus disease-2019 (COVID-19) to suggest the appropriate drug therapeutic approaches. Subsequent to the inclusion of 4 available studies, which presented all the required data, the findings and results were compared, showing fever and cough as the most prevalent clinical indications of both H1N1 influenza and 2019-nCoV diseases. With respect to the laboratory findings, both 2019-nCoV and H1N1 patients showed leukopenia as the main laboratory findings. Taken together, since ...
Source: Clinical Pulmonary Medicine - July 1, 2020 Category: Respiratory Medicine Tags: Critical Care/Respiratory Care Source Type: research
Introducing the Flow Triever Mechanical Thrombectomy Device: A Nonthrombolytic Catheter-directed Approach for Intermediate to High–risk Pulmonary Embolism
Synopsis: The FLARE (FlowTriever Pulmonary Embolectomy Clinical Study) is a prospective, single-arm, multicenter trial in which 106 patients at 18 different US sites with intermediate-risk pulmonary embolism (PE) were treated with percutaneous mechanical thrombectomy using the FlowTriever Retrieval/Aspiration System. The investigators found that the FlowTriever device met its primary effectiveness endpoint with a mean reduction in the right ventricular/left ventricular ratio at 48 hours of 0.38 (25.1%; P (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - May 1, 2020 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Should We Be Using High-flow Nasal Oxygen in Addition to Noninvasive Ventilation for Patients at High Risk for Extubation Failure?
Synopsis: A comparison of postextubation therapy with high-flow nasal oxygen (HFNO) with noninvasive ventilation with HFNO in mechanically ventilated patients at high risk for extubation failure showed an absolute risk reduction of 6.4% in reintubation rates for patients who received both noninvasive ventilation and HFNO. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - May 1, 2020 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
A Case of Vaping-associated Acute Lung Injury
Although vaping has been promoted by manufacturers as a safe alternative to traditional smoking, the dangers of vaping and e-cigarette use have come to the forefront of the medical community, particularly the risks associated with tetrahydrocannabinol-containing products. Although many patterns of vaping-associated lung injuries have been reported in the literature, one of the most concerning is that of diffuse alveolar damage. As e-cigarette and vaping use is becoming increasingly popular, particularly in the younger population, it is important to become familiar with this entity to ensure proper and timely diagnosis to p...
Source: Clinical Pulmonary Medicine - May 1, 2020 Category: Respiratory Medicine Tags: Critical Care and Images Source Type: research
Bronchoscopic Myths and Legends: Utility of Bronchoscopy in ILD: A Review Article
This article reviews where the literature stands now on the utility of bronchoscopy in diagnosing ILDs. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - May 1, 2020 Category: Respiratory Medicine Tags: Clinical Myths & Evidence-Based Medicine Source Type: research
Monitoring Asthma in Pregnancy: Diagnosis and Treatment
Asthma is one of the most common problems that complicate pregnancy. Several maternal and fetal complications make it difficult for the physician to treat asthmatic pregnant women. Asthma not only affects the maternal quality of life but also increases the risk of adverse perinatal outcomes. Managing asthma along with proper diagnosis should be given special emphasis during pregnancy. Pregnant asthmatic patients are at an increased risk of preterm birth, congenital malformations, respiratory disorders, and other complications. Thus, optimum management of asthma along with appropriate pharmacological therapies during pregna...
Source: Clinical Pulmonary Medicine - May 1, 2020 Category: Respiratory Medicine Tags: Colleagues in Respiratory Medicine Source Type: research
