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 structures that ...
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
