Immunosuppressive Treatment Regimens in Connective Tissue Disease–associated Interstitial Lung Disease
The management of interstitial lung disease due to connective tissue disease presents a challenge for clinicians, as this is a heterogeneous group of diseases, and there are no clear guidelines to follow, with only sparse randomized controlled trials available to guide therapy. Multiple different medications have been used for the treatment of interstitial lung disease due to connective tissue disease, with mostly retrospective studies or small case series documenting their efficacy. Ultimately, the choice of medication, the dosage, and the duration of therapy should be individualized for each patient after weighing the ri...
Source: Clinical Pulmonary Medicine - November 1, 2018 Category: Respiratory Medicine Tags: Interstitial, Inflammatory and Occupational Lung Disease Source Type: research
Management of Malignant Pleural Effusion
Malignant pleural effusion is a common clinical problem with an increasing incidence that may be seen to complicate the management of almost all forms of cancer. It is associated with a very poor median survival leading to a palliative management approach. Several methods are available in the management of malignant pleural effusion including simple pleural aspiration, talc pleurodesis, or indwelling pleural catheters. Patient selection, however, remains difficult. The role for each management option, their indications, predictors of success, and factors influencing patient selection are all crucial considerations and are ...
Source: Clinical Pulmonary Medicine - November 1, 2018 Category: Respiratory Medicine Tags: Topics in Pulmonary Medicine Source Type: research
Screening of Obstructive Sleep Apnea: A Review of Questionnaire-based Tools
Obstructive sleep apnea (OSA) is a significant problem resulting from the obstruction of the upper airway. It leads to cardiovascular disorders, cognitive impairment, epilepsy, fatigue, sleepiness, diabetes, and perioperative complications. It is important to identify and treat OSA before it leads to other comorbidities. Thus, reliable questionnaire-based methods have been developed for screening this disease. This review article elaborates the most common questionnaires used for the screening of OSA: the STOP questionnaire, STOP-Bang questionnaire, Berlin questionnaire, Epworth Sleepiness Scale, Fatigue Severity Scale, an...
Source: Clinical Pulmonary Medicine - November 1, 2018 Category: Respiratory Medicine Tags: Topics in Pulmonary Medicine Source Type: research
Evidence of Efficacy of Intrabronchial Valves for Persistent Air leak
The management of persistent air leaks remains a common and challenging clinical problem. The introduction of intrabronchial valves has offered an alternative intervention for air-leak management; however, the efficacy of these valves remains unclear. Numerous case reports and case series currently exist as well as some larger trials; however, many remained plagued with shortcomings of retrospective, often single-center descriptions. Within this review, we attempt to describe the history of intrabronchial valves, the current intrabronchial valve systems available for use, and the current literature available evaluating int...
Source: Clinical Pulmonary Medicine - November 1, 2018 Category: Respiratory Medicine Tags: Interventional Pulmonary Medicine Source Type: research
Respiratory Tract Colonization by Candida Species Portends Worse Outcomes in Immunocompromised Patients
The significance and clinical management of Candida colonization of the respiratory tract are ill-defined. We now report the frequency of Candida species from the lower respiratory tract in hematopoietic stem cell transplant recipients (HSCT) undergoing bronchoscopy with broncheoalveolar lavage for pneumonitis after HSCT. The University of Michigan Clinical Microbiology Laboratory Database was queried for all respiratory cultures positive for Candida species between 2000 and 2012. We concurrently performed a retrospective analysis of 515 HSCT recipients with pneumonitis at our institution between 2001 and 2012. During this...
Source: Clinical Pulmonary Medicine - November 1, 2018 Category: Respiratory Medicine Tags: Respiratory Infections Source Type: research
IMPACT Trial: Triple Versus Dual Therapy for COPD Results in Decreased Rate of Exacerbations
Synopsis: Despite clinical guidelines recommending triple therapy with an inhaled corticosteroid (ICS), long-acting muscarinic receptor antagonist (LAMA), and long-acting beta-agonist (LABA) for individuals with GOLD D chronic obstructive pulmonary disease, the evidence supporting this is weak. The IMPACT study was a randomized controlled trial that provided evidence that exacerbation risk is decreased in patients using triple therapy compared with an ICS/LABA or LAMA/LABA.
Source: Lipson DA, Barnhart F, Brealey N, et al. Once-daily single-inhaler triple versus dual therapy in patients with chronic obstructive pulmonary d...
Source: Clinical Pulmonary Medicine - September 1, 2018 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Pembrolizumab Plus Chemotherapy in Patients With Previously Untreated Metastatic Non–small Cell Lung Cancer Without EGFR or ALK Mutations is Superior to Chemotherapy Alone
Synopsis: In this double-blind, phase 3 trial, the addition of pembrolizumab to standard chemotherapy with a platinum-based drug and pemetrexed resulted in better overall survival, progression-free survival, as well as tumor response rate among patients with previously untreated metastatic nonsquamous, non–small cell lung cancer without sensitizing epidermal growth factor receptor or anaplastic lymphoma kinase mutations.
Source: Leena Gandhi, Delvys Rodriguez-Abreu, Shirish Gadgeel, et al. Pembrolizumab plus chemotherapy in metastatic non–small cell lung cancer. New England Journal of Medicine. 2018. Doi:10.1056/NEJMo...
Source: Clinical Pulmonary Medicine - September 1, 2018 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Thin-walled Cystic Pulmonary Lesions: Rare Considerations
A pulmonary cyst may be defined as an abnormal pulmonary parenchymal space, not containing lung but filled with air and/or fluid, congenital or acquired in etiology, typically with a circumscribed interface with adjacent normal lung, and a wall thickness>1 mm. Pulmonary cysts are not infrequent abnormalities at thoracic computed tomography. Occasionally, pulmonary cysts are incidentally encountered at thoracic imaging studies and, when limited in number, may even be regarded as a consequence of normal age-related pulmonary changes. The causes of cysts within the lung parenchyma are numerous, and pulmonary cysts should be...
Source: Clinical Pulmonary Medicine - September 1, 2018 Category: Respiratory Medicine Tags: Images in Pulmonary Medicine Source Type: research
RNA Acquisition From Transbronchial Needle Aspiration in Non–Small Cell Lung Cancer
The current complexity of non–small cell lung lies in multiple histologies, targetable mutations, and gene expression, all of which are necessary information for structuring treatment and formulating prognosis. Obtaining this information from small-volume biopsies can present unique challenges, and researchers are exploring RNA analysis to elicit this. RNA analysis is already being used in other malignancies such as those of the breast and thyroid. We performed a review of the literature, demonstrating that sufficient material can be obtained through RNA specimens collected during endobronchial ultrasound-guided transbro...
Source: Clinical Pulmonary Medicine - September 1, 2018 Category: Respiratory Medicine Tags: Clinical Myths and Evidence-Based Medicine Source Type: research
Role for Sampling Nonpalpable Supraclavicular Lymph Nodes Found by Ultrasound at the Time of EBUS-TBNA: A Single-center Pilot Study
In conclusion, we propose that ultrasound fine-needle aspiration of SCLN is feasible and can be highly diagnostic in these high-risk patients. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - September 1, 2018 Category: Respiratory Medicine Tags: Interventional Pulmonary Medicine Source Type: research
Aspiration: /aspə’rāSH(ə)n/ Noun An Ambiguous Term Used for a Diagnosis of Uncertainty
This article reviews the literature and classifies 13 distinct syndromes, grouped into 3 categories to help delineate the different disease states associated with pulmonary aspiration. Chronic anaerobic pulmonary infection should be most precisely referred to as anaerobic pneumonia. The commonly used term, aspiration pneumonia, is misleading to clinicians and should be abandoned. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - September 1, 2018 Category: Respiratory Medicine Tags: Topics in Pulmonary Medicine Source Type: research
The Diagnosis of Pulmonary Tuberculosis: Established and Emerging Approaches for Clinicians in High-income and Low-income Settings
Despite substantial improvements in global tuberculosis (TB) control over the past 2 decades, TB remains the ninth leading cause of death worldwide and the leading cause of death from a single infectious agent. From the perspective of both TB control programs and treating clinicians, rapid diagnosis of active pulmonary TB is crucial to identify potentially infectious persons, facilitate prompt initiation of treatment, and mitigate transmission. Although sputum smear microscopy and mycobacterial culture have traditionally been used for diagnosis, molecular diagnostic methods have evolved considerably over the past 2 decades...
Source: Clinical Pulmonary Medicine - September 1, 2018 Category: Respiratory Medicine Tags: Respiratory Infections Source Type: research
Systemic Lupus Erythematosus–associated Diffuse Alveolar Hemorrhage: A Case Report and Review of the Literature
Systemic lupus erythematosus is associated with numerous pleuropulmonary complications. Although uncommon, diffuse alveolar hemorrhage (DAH) represents a life-threatening cause of acute respiratory failure among patients with lupus. Here, we present a 24-year-old woman with a history of lupus who developed hemoptysis and respiratory failure associated with diffuse radiographic infiltrates and anemia. Bronchoscopy confirmed DAH. She was managed with supportive care, plasmapheresis, and immunosuppressive pharmacotherapy, leading to sustained resolution of her pulmonary hemorrhage and respiratory failure. We review the availa...
Source: Clinical Pulmonary Medicine - September 1, 2018 Category: Respiratory Medicine Tags: Topics in Pulmonary Medicine Source Type: research
Interstitial Lung Disease in the Elderly: A Review of Pathogenesis and Clinical Management
As the human lifespan continues to rise, the number of elderly patients with interstitial lung disease (ILD) has never been higher. Idiopathic pulmonary fibrosis is the most common ILD among older patients, but ILD related to autoimmune disease and hypersensitivity pneumonitis are also important diseases in this age group. Usual interstitial pneumonia is the histopathologic pattern of IPF; mitochondrial dysfunction, oxidative stress from telomere damage, and endoplasmic reticular stress from the unfolded protein response are the aging processes implicated in alveolar epithelial cell injury and downstream aberrant fibroblas...
Source: Clinical Pulmonary Medicine - September 1, 2018 Category: Respiratory Medicine Tags: Interstitial, Inflammatory & Occupational Lung Disease Source Type: research
Can Fractional Exhaled Nitric Oxide Predict Responsiveness to Inhaled Corticosteroids?
This study showed that there might be utility to this test in the evaluation of patients without a known asthma diagnosis but who present with nonspecific respiratory symptoms.
Source: Price DB et al. Fractional exhaled nitric oxide (FeNO) as a predictor of response to inhaled corticosteroids (ICS) in patients with nonspecific respiratory symptoms and insignificant bronchodilator reversibility: a randomized controlled trial. Lancet Respir Med. 6(1): 29–39. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - July 1, 2018 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
