Palliative Care For Patients With Advanced Chronic Obstructive Pulmonary Disease (COPD) Remains Underutilized
Synopsis: COPD patients experience distressing symptoms and a poor quality of life. This population-based, repeated cross-sectional study suggests that palliative strategies in advanced disease remain underutilized.
Source: Gershon AS, Maclagan LC, Luo J, et al. End-of-life strategies among patients with advanced chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2018;198:1389–1396. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - May 1, 2019 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Unilateral Multicystic Pulmonary Disease in a Young Adult: An Unusual Diagnosis
We present a case of a 20-year-old woman diagnosed with unilateral entire lung CPAM on the basis of radiologic findings that was surgically resected via video-assisted thoracoscopic surgery. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - May 1, 2019 Category: Respiratory Medicine Tags: Images in Pulmonary Medicine Source Type: research
Lung Ultrasound for Daily Monitoring and Management of ARDS Patients
Lung ultrasound has greatly developed in the last decade, becoming increasingly important both for the diagnosis and for the monitoring of acute respiratory failure; it can be used on a daily basis at the bedside to improve the clinical assessment of the critically ill. This review describes how lung ultrasound can be used to assess patients with acute respiratory distress syndrome (ARDS), from the initial diagnosis to the daily management and monitoring. Quantification of lung aeration can be performed at the bedside with the lung ultrasound score; it is reliable when compared with computed tomography scan, easy to learn,...
Source: Clinical Pulmonary Medicine - May 1, 2019 Category: Respiratory Medicine Tags: Critical Care/Respiratory Care Source Type: research
Noninvasive Oxygenation Strategies For Acute Exacerbation of Interstitial Lung Disease: A Retrospective Single-center Study and a Review of the Literature
Acute exacerbation of interstitial lung disease (AE-ILD) causes severe respiratory failure so that the patients would often require mechanical ventilation. Mechanical ventilation may improve survival in selected patients with AE-ILD; however, in-hospital mortality rate is so high in patients who need mechanical ventilation that the use of mechanical ventilation is weakly recommended. Although there is no fixed strategy with regard to selection of oxygen devices, a palliative approach to how to spend the end-of-life periods is often needed. Although noninvasive ventilation may be used to avoid intubation, high-flow nasal ca...
Source: Clinical Pulmonary Medicine - May 1, 2019 Category: Respiratory Medicine Tags: Interstitial, Inflammatory & Occupational Lung Disease Source Type: research
A Novel Therapeutic Approach Using the Combination of Vacuum-assisted Closure System and 1-Way Valve After Open-Window Thoracostomy in Treating Chronic Empyema Complicated by Multiple Bronchopleural Fistulae
Empyema thoracis may be an ancient disease, but it still occurs in present-day thoracic practice. Despite medical and technical progression, pleural infection remains a major health care concern. When empyema thoracis is complicated by bronchopleural fistulae or repeated infections, it becomes a clinical challenge to physicians and can substantially lengthen and complicate a patient’s course of treatment. This case report presents a 48-year-old male patient with chronic empyema and multiple bronchopleural fistulae who was effectively treated by a combination of a 1-way valve and vacuum-assisted closure system through ope...
Source: Clinical Pulmonary Medicine - May 1, 2019 Category: Respiratory Medicine Tags: Interventional Pulmonary Medicine Source Type: research
The Clinical and Research Utility of Bronchoscopy in Cystic Fibrosis
Bronchoscopy is used in the management of cystic fibrosis (CF) for multiple reasons, of which sampling respiratory secretions has been the most frequent. The evidence behind the role of bronchoscopy for routine sampling of respiratory secretions to determine clinical management is lacking, although there remain well-accepted indications for bronchoscopy in research and follow-up of advanced therapies in the CF population. We review the clinical and research utility of bronchoscopy in patients with CF and outline promising research uses of this tool that can contribute to recent advances in understanding and treating CF. (S...
Source: Clinical Pulmonary Medicine - May 1, 2019 Category: Respiratory Medicine Tags: Topics in Pulmonary Medicine Source Type: research
Subtle But Clinically Significant: A Review of Antibody Deficiencies in Adults
Primary immunodeficiency diseases are becoming more frequently diagnosed in the adult population. Although infections are the most common symptoms, patients can also present with sequelae of autoimmune and noninfectious pulmonary diseases, such as interstitial lung disease and granulomatous disease. Pulmonologists are likely to encounter patients with various and, at times, subtle symptoms suggestive of immunodeficiency. In this review article, we discuss the presentation, evaluation, and management of 4 antibody deficiencies: common variable immunodeficiency, selective immunoglobulin A deficiency, specific antibody defici...
Source: Clinical Pulmonary Medicine - May 1, 2019 Category: Respiratory Medicine Tags: Respiratory Infections Source Type: research
Myth: For Bronchoscopy Training in the 21st Century, there is a Standard Curriculum or Metrics for EBUS-TBNA Bronchoscopy Education With Good Supporting Evidence: Erratum
No abstract available (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - March 1, 2019 Category: Respiratory Medicine Tags: Erratum Source Type: research
Zephyr Endobronchial Valves Improve FEV1 and Quality of Life in Heterogenous Emphysema
Synopsis: In patients with severe heterogenous emphysema and little or no collateral ventilation in target lobes, Zephyr Endobronchial Valve treatment provides statistical and clinical benefits in lung function and quality of life compared with current standard of care therapies over a 12-month period.
Source: Criner GJ, Sue R, Wright S, et al. LIBERATE Study Group. A multicenter randomized controlled trial of Zephyr endobronchial valve treatment in heterogenous emphysema (LIBERATE). Am J Respir Crit Care Med 2018;198:1151–1164. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - March 1, 2019 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Efficacy of Dupilumab for Treatment of Moderate-to-Severe Asthma
Synopsis: Dupilumab is a novel biologic agent that targets the shared interleukin 4/13 receptor. It is safe and efficacious in patients with moderate-to-severe asthma; however, subgroup analysis suggests that patients with elevated markers of type-2 inflammation benefit most from this drug.
Source: Castro M, Corren J, Pavord ID, et al. Dupilumab efficacy and safety in moderate-to-severe uncontrolled asthma. NEJM 2018;378:2486–2496. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - March 1, 2019 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Cough and Nasal Pain: Putting Together an Uncommon Diagnosis
The pulmonary vasculitides include a wide spectrum of disorders that have in common inflammation and destruction of pulmonary blood vessels. Granulomatosis with polyangiitis (GPA), formerly known as Wegener granulomatosis, is the most common of the antineutrophil cytoplasmic antibody–associated small-vessel vasculitides, and affects a number of organ systems. GPA affects a wide age range, although it typically presents in middle adulthood. The classic triad of GPA—upper airway involvement (sinusitis, otitis media, mucosal ulcerations, airway inflammation), lower respiratory tract disease, and glomerulonephritis—is no...
Source: Clinical Pulmonary Medicine - March 1, 2019 Category: Respiratory Medicine Tags: Images In Pulmonary Medicine Source Type: research
Bronchoscopy in the Immunosuppressed Patient
Bronchoscopy in the immunosuppressed patient is routinely undertaken, as mortality of immunosuppressed hosts with pulmonary infiltrates is high. Generally, complications from bronchoscopy are rare, with pneumothorax and respiratory failure being the most serious. Immunosuppressed hosts do not have a higher complication rate than the general patient. In patients with HIV, bronchoscopy should be undertaken even if sputum samples are negative when suspicion is high for Pneumocystis jirovecii or tuberculosis. Patients with a hematologic malignancy have a high incidence of pulmonary infiltrates, and delaying bronchoscopy can si...
Source: Clinical Pulmonary Medicine - March 1, 2019 Category: Respiratory Medicine Tags: Clinical Myths and Evidence-Based Medicine Source Type: research
Neurological Emergencies in the Intensive Care Unit
Neurological emergencies present a unique challenge in the intensive care unit, requiring rapid evaluation and treatment. There is a complex interplay in critically ill patients, wherein illness affects the brain and the brain can, in turn, affect the illness, making diagnosis and management challenging. In this review, we discuss the diagnosis and management of common neurological issues that may be encountered in the intensive care unit, including elevated intracranial pressure, traumatic brain injury, ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, status epilepticus, neurological complications of cr...
Source: Clinical Pulmonary Medicine - March 1, 2019 Category: Respiratory Medicine Tags: Colleagues in Respiratory Medicine Source Type: research
Management of Pulmonary Vasculitis: A Concise Review
The pulmonary vasculitides are an uncommon group of disorders that are characterized by inflammation and necrosis of the blood vessel wall, usually involving the small and medium-sized blood vessels in the lung. Management has traditionally involved the use of immunosuppressive agents and newer adjunctive therapies such as plasmapheresis. Recent trials over the last decade have highlighted the successful use of these agents in treating this life-threatening illness; however, much remains unknown in terms of exact dosing of these agents and duration of treatment. Adverse events from these therapies remain a serious concern ...
Source: Clinical Pulmonary Medicine - March 1, 2019 Category: Respiratory Medicine Tags: Interstitial, Inflammatory & Occupational Lung Disease Source Type: research
Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome: The Doctors are In, but the Jury is Still Out
Despite attempts to optimize outcomes in acute respiratory distress syndrome (ARDS) using mechanical ventilation and medical management, the mortality associated with this syndrome remains very high. The use of extracorporeal membrane oxygenation (ECMO), particularly veno-venous ECMO (VV-ECMO), as a rescue therapy has grown significantly in recent decades. This review outlines the risks and benefits of ECMO for the treatment of ARDS, examines the body of evidence behind this practice, including 4 randomized controlled trials and 2 case-controlled studies, and discusses the remaining questions and directions for future rese...
Source: Clinical Pulmonary Medicine - March 1, 2019 Category: Respiratory Medicine Tags: Critical Care/Respiratory Care Source Type: research
