How Does the Efficacy and Safety of Triple Inhaled Therapy at 2 Glucocorticoid Doses Compare With 2 Dual Therapies in Moderate-to-Very-Severe COPD?
Synopsis: This 52-week, phase 3, randomized, double-blind, parallel-group trial compared the efficacy and safety of twice-daily inhaled triple therapy with budesonide at 2 different doses (160 and 320-μg) plus a LAMA (18-μg of glycopyrrolate) and a LABA (9.6-μg of formoterol) in comparison with either glycopyrrolate-formoterol (18 and 9.6-μg) or budesonide-formoterol (320 and 9.6-μg) in patients with moderate-to-very-severe COPD with at least 1 exacerbation in the past year. Similar to previous trials, there was a significant reduction in the annual rate of moderate-to-severe exacerbations and improved patie...
Source: Clinical Pulmonary Medicine - September 1, 2020 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research

Dexamethasone in Acute Respiratory Distress Syndrome
Synopsis: In patients with moderate-to-severe acute respiratory distress syndrome (ARDS), defined as an arterial oxygen partial pressure/ fractional inspired oxygen (PaO2/FiO2) of 200 mm Hg or less with a positive end-expiratory pressure (PEEP) of 10 cm H2O or greater and FiO2>0.5, administration of dexamethasone within 24 hours of ARDS onset led to more ventilator-free days, and a reduction of all-cause mortality with no difference in adverse events. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - September 1, 2020 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research

Clinical and Radiologic Improvement Following Tocilizumab Administration in Patients With SARS-CoV-2
We report on 2 severely ill patients with COVID-19 treated with tocilizumab within 7 to 10 days of onset of symptoms. Tocilizumab markedly improved their clinical condition and was associated with regression of abnormalities on chest computed tomography within 1 week of tocilizumab administration. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - September 1, 2020 Category: Respiratory Medicine Tags: Images in Pulmonary Medicine Source Type: research

Laboratory Diagnosis of COVID-19
SARS-CoV-2 in bats was transmitted to humans by a peridomestic mammal in China and it was transmitted from humans to humans very quickly through coughing and sneezing and is spread all over the world and created coronavirus disease 2019. The disease causes a variety of symptoms in patients and it has killed a significant number of people around the world, especially people with underlying diseases such as heart disease, diabetes, and high blood pressure. Early diagnosis of patients is very important to prevent the transmission of the disease from humans to humans and the spread of the virus. The virus causes abnormal compu...
Source: Clinical Pulmonary Medicine - September 1, 2020 Category: Respiratory Medicine Tags: Clinical Practice Management Source Type: research

Immunotherapy-induced Pneumonitis: A Review of Diagnostic Workup and Treatment Guidelines
Lung cancer remains the leading cause of cancer-related deaths worldwide; however, new developments in treatment, specifically immune checkpoint inhibitors, have demonstrated improved progression-free survival. Unfortunately, these medications are not without side effects, including the potentially life-threatening side effect of immune-related pneumonitis. There are a paucity of data with regard to risk factors and diagnostic criteria, leading to a complicated diagnostic dilemma for providers. In addition, guidelines as regards treatment and reinitiation of therapy are sparse at best. Both these factors lead to significan...
Source: Clinical Pulmonary Medicine - September 1, 2020 Category: Respiratory Medicine Tags: Topics in Pulmonary Medicine Source Type: research

“Popcorn” Cavitary Pneumonia: A Case Report
Upper lobe cavitation carries a broad differential. No review, to our knowledge, includes foreign body in the differential diagnosis. Similarly, reviews of foreign body aspiration do not report lung cavitation. Herein, we report a case of an alert 58-year-old man who presented with sepsis secondary to presumed right upper lobe pneumonia. Computed tomography of the chest was significant for multiple loculated cavitary lesions. Subsequent bronchoscopy revealed a single kernel of popcorn impacted in the bronchus. Our case report highlights the importance of recognizing atypical presentations of foreign body aspiration. (Sourc...
Source: Clinical Pulmonary Medicine - September 1, 2020 Category: Respiratory Medicine Tags: Respiratory Infections/Images Source Type: research

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 biops...
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

A Case of Idiopathic Pulmonary Hemosiderosis in a 30-Year-Old Man
This report describes a young male patient who presented a clinical pattern of fatigue, dyspnea, and hemoptysis with iron-deficiency anemia. The iron-deficiency anemia in this patient was resistant to oral elemental iron therapy. This patient had typical findings on chest computed tomography (diffuse ground-glass opacities of the lungs) and bronchoalveolar lavage (detected siderophages). The patient obtained corticosteroid therapy after confirmation of idiopathic pulmonary hemosiderosis diagnosis, which led to improvement of symptoms in one week. This case report shows that early diagnosis and quick initiation of corticost...
Source: Clinical Pulmonary Medicine - May 1, 2020 Category: Respiratory Medicine Tags: Interstitial, Inflammatory & Occupational Lung Disease Source Type: research

New GINA Guidelines: Controversy Still Exists
This article reviews the reasons for the changes in the guide and the problems that could emerge in the management of the asthmatic patient. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - May 1, 2020 Category: Respiratory Medicine Tags: Obstructive Airways Disease Source Type: research

Does Metoprolol Influence the Risk of Exacerbation in a High-risk COPD Patient Population?
Synopsis: This prospective randomized trial investigates the influence of metoprolol in comparison with placebo on the risk of chronic obstructive pulmonary disease exacerbations. Contrary to results in previous observational studies, the results showed that patients with moderate to severe chronic obstructive pulmonary disease, with no prior indication for beta blockers, were at similar risk for exacerbations as the placebo group. The metoprolol group was associated with a higher risk of exacerbation leading to mechanical ventilation. In addition, metoprolol was associated with worsening symptoms of breathlessness. (Sourc...
Source: Clinical Pulmonary Medicine - March 1, 2020 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research

Does a 2-Day Course of Antibiotics Lower the Incidence of Ventilator-associated Pneumonia in Patients Undergoing Targeted Temperature Management Following Cardiac Arrest?
Synopsis: This double-blind, randomized control trial evaluated the efficacy of a 2-day course of amoxicillin-clavulanate in reducing the incidence of early ventilator-associated pneumonia in patients undergoing targeted temperature management following an out-of-hospital cardiac arrest with initial shockable rhythm. There was a significant reduction in the incidence of early ventilator-associated pneumonia in the treatment group when compared with placebo, but no reduction in ventilator-free days or mortality at day 28. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - March 1, 2020 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research

NUT Carcinoma Resulting in SVC Syndrome
NUT (nuclear protein in testis) carcinoma is a poorly differentiated aggressive subtype of squamous cell carcinoma. NUT carcinoma is characterized by genetic rearrangements involving the NUT gene, resulting in the formation of oncogenic fusion proteins, most commonly NUT-BRD4. Originally described as a thymic carcinoma with NUT gene rearrangement in children and young adults, NUT carcinoma has been shown to occur in adults in a variety of locations. It is typically seen as an aggressive large soft tissue mass infiltrating adjacent structures. Because of the aggressive nature of NUT carcinoma, patients typically present in ...
Source: Clinical Pulmonary Medicine - March 1, 2020 Category: Respiratory Medicine Tags: Images in Pulmonary Medicine Source Type: research

Bedside Rules for Managing Acid-Base Derangement in Respiratory Failure: Applications to COVID-19
Respiratory failure is typically associated with changes in pCO2 leading to respiratory alkalosis (type 1 failure) and respiratory acidosis (type 2). As a compensatory response, plasma HCO3 concentration decreases if pCO2 decreases and increases conversely. These secondary responses prevent large pH fluctuations. However, metabolic acid-base disorders may still occur as a consequence of dysfunction of other organs and/or medical treatments. To recognize superimposed acid-base disorders, the availability of an accurate prediction of the expected HCO3 that corresponds to a given pCO2 is crucial. In chronic hypocapnia, the co...
Source: Clinical Pulmonary Medicine - March 1, 2020 Category: Respiratory Medicine Tags: Critical Care/Respiratory Care Source Type: research

ARDS as the Presenting Complication of Hyperviscosity Syndrome in Chronic Lymphocytic Leukemia: A Case Report
Hyperviscosity syndrome (HVS) is an oncological emergency resulting from elevated cellular or protein fractions of blood causing respiratory or neurological symptoms. While the prevalence is relatively low in leukemias, there are only a few reports of HVS seen in chronic lymphoblastic leukemia patients. Here, we report a case of an unusual presentation of chronic lymphoblastic leukemia in a 73-year-old male patient with extreme hyperleukocytosis and HVS presenting as acute respiratory distress syndrome. He consulted our clinic with complaints of exertional dyspnea followed by an acute respiratory distress syndrome after ho...
Source: Clinical Pulmonary Medicine - March 1, 2020 Category: Respiratory Medicine Tags: Topics in Pulmonary Medicine Source Type: research

Transition From Intravenous to Subcutaneous Treprostinil in a Pediatric Patient With Pulmonary Hypertension
Pulmonary hypertension (PH) causes significant morbidity and mortality in children, and, while the treatment strategies for PH in adults are well studied and developed, few data exist for pediatric patients. In adult patients, successful transitions from intravenous (IV) epoprostenol to subcutaneous (SC) treprostinil are reported, but this information is limited for pediatric patients. Furthermore, while there are reports of SC to IV treprostinil in adults, there are no reports of the transition from IV to SC treprostinil. This case report recounts a successful transition from IV treprostinil to SC treprostinil in a pediat...
Source: Clinical Pulmonary Medicine - March 1, 2020 Category: Respiratory Medicine Tags: Clinical Practice Management Source Type: research

Moderate Sedation Versus General Anesthesia for Endobronchial Ultrasound-guided Transbronchial Biopsy in an Academic Training Center
Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is a widely used procedure for the diagnosis and staging of lung cancer. Several studies have shown the diagnostic utility of EBUS-TBNA effectiveness for decreasing the need for invasive mediastinal sampling. The current recommendation is that most patients with lung cancer should undergo mediastinal staging with EBUS-TBNA. EBUS-TBNA can be safely performed under general anesthesia or moderate sedation, and, according to previous studies, the choice of anesthesia on the effect of outcomes has been variable. We investigated differences between EBUS-TBNA p...
Source: Clinical Pulmonary Medicine - March 1, 2020 Category: Respiratory Medicine Tags: Interventional Pulmonary Medicine Source Type: research

Hope in Patients With Progressive Fibrosis Interstitial Lung Disease (PF-ILD)
Synopsis: In patients with progressive fibrosis interstitial lung disease, the use of nintedanib is associated with a significantly lower rate of decline in annual forced vital capacity (−80.8 mL/y with nintedanib and −187.8 mL/y with placebo). Patients on nintedanib had a higher rate of diarrhea (66.9% vs. 23.9%) and transaminitis. Source: Flaherty KR, Wells AU, Cottin V, et al. Nintedanib in progressive fibrosing interstitial lung diseases (INBUILD). N Engl J Med. Doi:10.1056/NEJMoa1908681. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - January 1, 2020 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research

The Prophylactic Use of Macrolide Antibiotics to Prevent Acute Exacerbations in Bronchiectasis
Synopsis: A systematic review and meta-analysis revealed that the use of prophylactic, long-term macrolides reduces the rate of acute exacerbations in patients with bronchiectasis. This is true across many subgroups including in patients with pseudomonal infection for which current guidelines do not recommend the use of macrolides. Source: Chalmers JD, Boersma W, Lonergan M, et al. Long term macrolide antibiotics for the treatment of bronchiectasis in adults: an individual participant data meta-analysis. Lancet Respir Med. 2019;7:860–869. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - January 1, 2020 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research

A Rare Cause for a Mediastinal Lesion
The term “mediastinum” refers to a tissue compartment that resides between the 2 lungs, posterior to the sternum, anterior to the spine, and extending from the thoracic inlet to the diaphragm. A great number of structures reside within this region, any of which can give rise to a wide variety of abnormalities. Lesions arising within the mediastinum often defy easy classification, owing to the complex anatomy of the region. By convention, the mediastinum is divided into 3 compartments: anterior (prevascular), middle (visceral), or posterior (paravertebral) compartments. Each compartment contains certain structur...
Source: Clinical Pulmonary Medicine - January 1, 2020 Category: Respiratory Medicine Tags: Images in Pulmonary Medicine Source Type: research

Role of Bronchoscopy in Atelectasis
Atelectasis is one of the most commonly encountered abnormalities in chest radiology and remains a daily diagnostic challenge. At times, atelectasis can be overlooked, particularly when pulmonary opacification is minimal or absent, and, at other times, it might be interpreted as being some other form of intrathoracic pathology, particularly pneumonia. Concern over prolonged atelectasis is that it may worsen hypoxemia through shunting and may predispose the patient to nosocomial pneumonia. Traditionally, the treatment of atelectasis has focused on suctioning with adjuncts such as chest physiotherapy, kinetic beds, therapy w...
Source: Clinical Pulmonary Medicine - January 1, 2020 Category: Respiratory Medicine Tags: Clinical Myths & Evidence-based Medicine Source Type: research

Concurrent Use of Biphasic Cuirass Ventilation and Low-intensity Noninvasive Positive Pressure Ventilation
Noninvasive positive pressure ventilation (NPPV) is widely used for ventilatory support, but is not effective in some conditions, such as pneumothorax. Biphasic cuirass ventilation (BCV) is a form of negative pressure ventilation that uses an external cuirass-style ventilator to support both inspiration and expiration at various cycle rates and pressures. BCV theoretically provides ventilation in a more natural manner than positive pressure ventilation and lowers the risk of barotrauma by preventing an increase in airway pressure. The concurrent use of BCV and NPPV may increase tidal volume and decrease the PaCO2 level to ...
Source: Clinical Pulmonary Medicine - January 1, 2020 Category: Respiratory Medicine Tags: Clinical Practice Management Source Type: research

Endoscopic Lung Volume Reduction: Implementation and Practical Considerations
Guidelines for treatment in severe chronic obstructive pulmonary disease with hyperinflation now include endobronchial lung volume reduction. Since December 2018, 2 valve systems have been Food and Drug Administration (FDA) approved, which has generated widespread interest in this new therapy for chronic obstructive pulmonary disease treatment. Although the technical placement of the endobronchial valves is relatively straightforward, this paper focuses on the multidisciplinary approach to identification, evaluation, and follow-up in addition to procedural techniques for endoscopic lung volume reduction implementation. (So...
Source: Clinical Pulmonary Medicine - January 1, 2020 Category: Respiratory Medicine Tags: Obstructive Airways Disease Source Type: research

Large Airway Complications Following Lung Transplantation
Airway complications following lung transplantation are common and may be associated with significant morbidity and mortality. Although there are multiple risk factors, anastomotic ischemia is the major factor for the development of airway complications. Most of the complications can be managed with bronchoscopic interventions. However, some may require surgical intervention even retransplantation. In recent years, a universally accepted definition and grading system have been published by the International Society for Heart and Lung Transplantation (ISHLT). Common airway complications include anastomotic dehiscence, anast...
Source: Clinical Pulmonary Medicine - January 1, 2020 Category: Respiratory Medicine Tags: Interventional Pulmonary Medicine Source Type: research

Hemothorax: A Review of the Literature
Hemothorax is a collection of blood in the pleural cavity usually from traumatic injury. A chest x-ray has historically been the imaging modality of choice upon arrival to the hospital. The sensitivity and specificity of point-of-care ultrasound, specifically through the Extended Focal Assessment with Sonography in Trauma (eFAST) protocol has been significant enough to warrant inclusion in most Level 1 trauma centers as an adjunct to radiographs. If the size or severity of a hemothorax warrants intervention, tube thoracostomy has been and still remains the treatment of choice. Most cases of hemothorax will resolve with tub...
Source: Clinical Pulmonary Medicine - January 1, 2020 Category: Respiratory Medicine Tags: Critical Care/Respiratory Care Source Type: research

Biomarkers in Pulmonary Infections: Erratum
No abstract available (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - November 1, 2019 Category: Respiratory Medicine Tags: Erratum Source Type: research

Can C-reactive Protein Testing Help Guide Antibiotic Therapy for Outpatients With COPD Exacerbations?
Synopsis: C-reactive protein may be a useful point-of-care tool to assist in antibiotic guidance in outpatients with an acute COPD exacerbation. This multicenter, randomized controlled trial demonstrated that CRP guided prescribing results in lower antibiotic use with no effect on quality of life. Source: Butler CC, Gillespie D, White P, et al. C-reactive protein testing to guide antibiotic prescribing for COPD exacerbations. N Engl J Med. 2019;381:111–120. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - November 1, 2019 Category: Respiratory Medicine Tags: Interventional Pulmonary Medicine Source Type: research

Corticosteroids in Community-acquired Pneumonia: To Give or Not To Give?
Synopsis: Several randomized controlled trials (RCTs) and meta-analyses have shown improved outcomes when using corticosteroids in community-acquired pneumonia (CAP), including shorter length of stay, reduced treatment failure, and even lower mortality rates in severe disease. In this reviewed study, a bundled intervention including corticosteroids did not improve outcomes and suggested that corticosteroids may even cause harm. Source: Lloyd M, Karahalios A, Janus E, et al. Effectiveness of a bundled intervention including corticosteroids on outcomes of hospitalized patients with community-acquired pneumonia. JAMA Intern ...
Source: Clinical Pulmonary Medicine - November 1, 2019 Category: Respiratory Medicine Tags: Interventional Pulmonary Medicine Source Type: research

When the Lesion Should Be There, But Isn’t …
Diagnostic imaging plays a prominent role in the evaluation of numerous medical conditions, ranging from suspected infections to assessment of the acutely injured patient to staging malignancies and numerous other conditions, both common and rare. Imaging can be a very powerful tool in the diagnosis of medical disorders and plays a major role in the assessment of therapeutic response as well. It is common in practice for imaging studies to provide findings that may corroborate the clinical or laboratory impression of a disorder, allowing a presumptive diagnosis and institution of therapy, often circumventing the morbidity ...
Source: Clinical Pulmonary Medicine - November 1, 2019 Category: Respiratory Medicine Tags: Images in Pulmonary Medicine Source Type: research

Medical Malpractice and Bronchoscopy: Why Do Physicians Face Litigation?
Despite bronchoscopy’s minimally invasive approach, it is not without errors and complications. When such errors do occur, patients may seek legal redress. The aim of the study was to describe the setting, contributing characteristics, and outcomes of litigation targeting bronchoscopic procedures. Westlaw (Thompson Reuters), an online legal research data set, was queried for all medical malpractice cases reported in the United States from 1983 to 2018 wherein bronchoscopy was performed. A total of 87 cases were included. Pulmonology was the most common specialty named in the cases (n=42, 48%). The most common alleged...
Source: Clinical Pulmonary Medicine - November 1, 2019 Category: Respiratory Medicine Tags: Topics in Pulmonary Medicine Source Type: research

Diffuse Alveolar Hemorrhage in the Setting of an Acute Exacerbation of Chronic Hypersensitivity Pneumonitis Due to Drug Rash With Eosinophilia and Systemic Symptoms: A Case Report
Drug rash with eosinophilia and systemic symptoms (DRESS) is a well-recognized phenomenon that is considered to be a hyperinflammatory reaction in response to the administration of a drug. It is typical to have systemic signs of inflammation, and the most commonly reported pulmonary manifestations include pneumonitis, interstitial lung disease, and acute respiratory distress syndrome. Here, we present a 62-year-old woman with a history of chronic hypersensitivity pneumonitis who presented in respiratory distress with a new progressive rash. Bronchoscopy demonstrated diffuse alveolar hemorrhage (DAH), and a clinical diagnos...
Source: Clinical Pulmonary Medicine - November 1, 2019 Category: Respiratory Medicine Tags: Critical Care/Respiratory Care/Interstitial and Inflammatory Lung Disease Source Type: research

The Safety and Efficacy of General Anesthesia Bronchoscopy in Patients With Metastatic Brain Lesions
Conclusion: These results confirm that the rate of serious complications in patients with space-occupying brain lesions who undergo bronchoscopy with general anesthesia is similar to that in patients without brain lesions, indicating that bronchoscopy can be performed safely in this patient population. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - November 1, 2019 Category: Respiratory Medicine Tags: Interventional Pulmonary Medicine Source Type: research

Poncet Disease: A Case-based Review of an Uncommon Extrapulmonary Manifestation of Tuberculosis
Discussion: This case of an immunocompromised woman with fevers, lymphadenopathy, polyarthritis, and erythema nodosum demonstrates a unique presentation of TB. PD is defined as reactive arthritis due to infection with TB elsewhere in the body. Although PD was first described in 1897, it stills remains a disputed and lesser-known entity. This case highlights the importance of recognizing this unique manifestation of TB to prevent misdiagnosis and delay. It also demonstrates the diagnostic challenge in distinguishing the overlapping features of sarcoidosis manifesting as Lofgren syndrome and PD. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - November 1, 2019 Category: Respiratory Medicine Tags: Respiratory Infections Source Type: research

Inhaled Tranexamic Acid: A Therapeutic Option For Hemoptysis
Synopsis: A prospective randomized, double-blinded, placebo-controlled trial in patients with nonmassive hemoptysis demonstrated that inhaled tranexamic acid significantly reduced the volume of expectorated blood with a higher rate of hemoptysis resolution, decreased the need for invasive procedures, shortened the length of hospital stay, and reduced the recurrence rate at 1-year follow-up, compared with placebo. However, its role in patients with massive hemoptysis remains an open question. Source: Wand O, Guber E, Guber A, et al. Inhaled tranexamic acid for hemoptysis treatment, a randomized controlled trial. Chest. 201...
Source: Clinical Pulmonary Medicine - September 1, 2019 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research

Does Aspirin Use Influence Exacerbations and Morbidity of Chronic Obstructive Pulmonary Disease?
Synopsis: Aspirin use has led to an improvement in mortality rate in coronary artery disease (CAD) patients, but there are not many studies showing mortality benefit in chronic obstructive pulmonary disease (COPD) patients. A recent observational cohort study assessed its influence on acute exacerbation of COPD, respiratory morbidity, and quality of life. The results showed a promising therapeutic use for aspirin, but further randomized controlled trials are necessary for a more definitive answer. Source: Fawzy A, Putcha N, Aaron CP, et al. Aspirin use and respiratory morbidity in COPD: a propensity score-matched analysis...
Source: Clinical Pulmonary Medicine - September 1, 2019 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research

Pity The Fool Who Extubates Too Soon: Does T-Piece Weaning Have Better Outcomes Compared With Standard Pressure Support Weaning?
Synopsis: A spontaneous breathing trial consisting of 30 minutes of pressure support ventilation, compared with 2 hours of T-piece ventilation, led to significantly higher rates of successful extubation. Source: Subirá C, Hernández G, Vázquez A, et al. Effect of pressure support versus T-piece ventilation strategies during spontaneous breathing trials on successful extubation among patients receiving mechanical ventilation: a randomized clinical trial. JAMA. 2019;321:2175–2182. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - September 1, 2019 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research

Is This the End of Albuterol?
Synopsis: In patients with mild asthma, a strategy of budesonide-formoterol as needed was superior to albuterol as needed to prevent asthma exacerbations. Source: Beasley R, Holiday M, Reddel HK, et al. Controlled trial of budesonide-formoterol as needed for mild asthma. N Engl J Med. 2019;380:2020–2030. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - September 1, 2019 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research