Biomarkers in Lung Cancer
This article provides an overview of lung cancer biomarker development, focusing on clinical utility and highlighting 2 unmet clinical needs: selection of high-risk patients for lung cancer screening and differentiation of early lung cancer from benign pulmonary nodules. The authors highlight biomarkers under development and those lung cancer screening and nodule management biomarkers post-clinical validation. Finally, trends in lung cancer biomarker development that may improve accuracy and accelerate implementation in practice are discussed. (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - January 2, 2020 Category: Respiratory Medicine Authors: Catherine R. Sears, Peter J. Mazzone Source Type: research

Lung Cancer in Women
Lung cancer in women is a modern epidemic and a major health crisis. Cigarette smoking remains the most important risk factor for lung cancer, and unfortunately smoking rates are either stabilized or continue to increase among women. Women may not be more susceptible to the carcinogenic effects of tobacco, but the biology of lung cancer differs between the sexes. This paper summarizes the biological sex differences in lung cancer, including molecular abnormalities, growth factor receptors, hormonal influences, DNA repair capacity, as well as differences in the histology and treatment outcomes of lung cancer in women. (Sour...
Source: Clinics in Chest Medicine - January 2, 2020 Category: Respiratory Medicine Authors: Christina R. MacRosty, M. Patricia Rivera Source Type: research

Lung Cancer Pathology
Lung cancer can be diagnosed based on histologic biopsy or cytologic specimens. The 2015 World Health Organization Classification of Lung Tumors addressed the diagnosis of lung cancer in resection specimens and in small biopsies and cytology specimens. For these small specimens, diagnostic terms and criteria are recommended. Targetable mutations such as EGFR and ALK rearrangements emphasize the importance of managing these small specimens for molecular testing. (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - January 2, 2020 Category: Respiratory Medicine Authors: William D. Travis Source Type: research

Therapeutic Bronchoscopic Techniques Available to the Pulmonologist
Therapeutic bronchoscopy for both endobronchial tumors and peripheral lung cancer is rapidly evolving. The expected increase in early stage lung cancer detection and significant improvement in near real-time imaging for diagnostic bronchoscopy has led to the development of bronchoscopy-delivered ablative technologies. Therapies targeting obstructing central airway tumors for palliation and as a method of local disease control, patient selection and patient-centered outcomes have been areas of ongoing research. This review focuses on patient selection when considering therapeutic bronchoscopy and new and developing technolo...
Source: Clinics in Chest Medicine - January 2, 2020 Category: Respiratory Medicine Authors: Matt Aboudara, Otis Rickman, Fabien Maldonado Source Type: research

Epidemiology of Tuberculosis in the United States
Although considerable progress has been made in reducing US tuberculosis incidence, the goal of eliminating the disease from the United States remains elusive. A continued focus on preventing new tuberculosis infections while also identifying and treating persons with existing tuberculosis infection is needed. Continued vigilance to ensure ongoing control of tuberculosis transmission remains key. (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - November 13, 2019 Category: Respiratory Medicine Authors: Adam J. Langer, Thomas R. Navin, Carla A. Winston, Philip LoBue Source Type: research

New Concepts in Tuberculosis Host Defense
Tuberculosis (TB) host defense depends on cellular immunity, including macrophages and adaptively acquired CD4+ and CD8+ T cells. More recently, roles for new immune components, including neutrophils, innate T cells, and B cells, have been defined, and the understanding of the function of macrophages and adaptively acquired T cells has been advanced. Moreover, the understanding of TB immunology elucidates TB infection and disease as a spectrum. Finally, determinates of TB host defense, such as age and comorbidities, affect clinical expression of TB disease. Herein, the authors comprehensively review TB immunology with an e...
Source: Clinics in Chest Medicine - November 13, 2019 Category: Respiratory Medicine Authors: David M. Lewinsohn, Deborah A. Lewinsohn Source Type: research

Tuberculosis and Biologic Therapies
Biologic drugs have revolutionized the treatment of certain hematologic, autoimmune, and malignant diseases, but they may place patients at risk for reactivation or acquisition of tuberculosis. This risk is highest with the tumor necrosis factor-alpha (TNF- α) inhibitors. Amongst this class of drugs, the monoclonal antibodies (infliximab, adalimumab, golimumab) and antibody fragment (certolizumab) carry an increased risk compared to the soluble receptor fusion molecule, etanercept. Treatment of latent TB is critical to decrease the risk of reactivatio n. Data continues to emerge regarding tuberculosis risk associated...
Source: Clinics in Chest Medicine - November 13, 2019 Category: Respiratory Medicine Authors: Mark S. Godfrey, Lloyd N. Friedman Source Type: research

How Can the Tuberculosis Laboratory Aid in the Patient-Centered Diagnosis and Management of Tuberculosis?
In 2019, tuberculosis is still a global source of morbidity and mortality. To determine and provide the most effective treatment regimen to patients, the tuberculosis laboratory needs to rapidly but reliably answer 2 main questions: (1) Is Mycobacterium tuberculosis detectable in the patient specimen? and (2) If so, is the strain detected drug susceptible or does it show any form of drug resistance? In cases of drug resistance, health care providers need to have access to minimal inhibitory concentration results and to the type of mutation conferring drug resistance to tailor the most appropriate drug regimen. (Source: Cli...
Source: Clinics in Chest Medicine - November 13, 2019 Category: Respiratory Medicine Authors: Akos Somoskovi, Max Salfinger Source Type: research

Tuberculosis Supranational Reference Laboratories
The World Health Organization Supranational TB Reference Laboratory Network (SRLN) has served as the backbone for TB drug-resistance surveillance and diagnosis since 1994 and remains a key WHO programme for antimicrobial resistance (AMR) surveillance at the global level. SRLN is a great technical resource for proficiency testing to ensure accuracy of drug-susceptibility testing, scale-up, capacity development in countries and provides unique support to the reliable detection of drug resistance. Technical assistance from individual SRLs has been supported by a variety of mechanisms but funding for the SRLN has become increa...
Source: Clinics in Chest Medicine - November 13, 2019 Category: Respiratory Medicine Authors: Christopher Gilpin, Fuad Mirzayev Source Type: research

Treatment of Drug-Susceptible Tuberculosis
This article focuses on preferred regimens of drug-susceptible tuberculosis under current guidelines by the American Thoracic Society, Centers for Disease Control and Prevention, and Infectious Diseases Society of America and World Health Organization. In addition, topics including patient centered care, poor treatment outcomes, and adverse effects are also discussed. (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - November 13, 2019 Category: Respiratory Medicine Authors: Beth Shoshana Zha, Payam Nahid Source Type: research

Diagnostic Tests for Latent Tuberculosis Infection
Diagnosing latent tuberculosis (TB) infection (LTBI) is important globally for TB prevention. LTBI diagnosis requires a positive test for infection and negative evaluation for active disease. Current tests measure an immunologic response and include the tuberculin skin test (TST) and interferon-gamma release assays (IGRAs), T-SPOT.TB and QuantiFERON. The IGRAs are preferred in bacille Calmette-Gu érin–vaccinated populations. The TST is still used when cost or logistical advantages over the IGRAs exist. Both TST and IGRAs have low positive predictive values. Tests that differentiate the TB spectrum and better p...
Source: Clinics in Chest Medicine - November 13, 2019 Category: Respiratory Medicine Authors: Michelle K. Haas, Robert W. Belknap Source Type: research

Treatment of Latent Tuberculosis Infection —An Update
Treatment of latent tuberculosis infection (LTBI) is an important component of TB control and elimination. LTBI treatment regimens include once-weekly isoniazid plus rifapentine for 3 months, daily rifampin for 4 months, daily isoniazid plus rifampin for 3 –4 months, and daily isoniazid for 6–9 months. Isoniazid monotherapy is efficacious in preventing TB disease, but the rifampin- and rifapentine-containing regimens are shorter and have similar efficacy, adequate safety, and higher treatment completion rates. Novel vaccine strategies, host immuni ty-directed therapies and ultrashort antimicrobial regimens for ...
Source: Clinics in Chest Medicine - November 13, 2019 Category: Respiratory Medicine Authors: Moises A. Huaman, Timothy R. Sterling Source Type: research

The Future of Vaccines for Tuberculosis
Exciting clinical results from 2 clinical TB vaccine trials were published in 2018. These, plus promising preclinical candidates form a healthy pipeline of potential vaccines against the leading cause of death from a single infectious agent. The only licensed vaccine, the BCG, continues to be an important tool in protecting against severe forms of TB in children, but has not stopped the diseases causing 1.3 million deaths per year. This review provides an overview of the current TB vaccine pipeline, highlighting recent findings, describes work relating to epidemiologic impact of vaccines, and discusses the future of TB vac...
Source: Clinics in Chest Medicine - November 13, 2019 Category: Respiratory Medicine Authors: Lisa Stockdale, Helen Fletcher Source Type: research

Preventing Transmission of Mycobacterium Tuberculosis —A Refocused Approach
Traditional tuberculosis (TB) infection control focuses on the known patient with TB, usually on appropriate treatment. A refocused, intensified TB infection control approach is presented. Combined with active case finding and rapid molecular diagnostics, an approach called FAST is described as a convenient way to call attention to the untreated patient. Natural ventilation is the mainstay of air disinfection in much of the world. Germicidal ultraviolet technology is the most sustainable approach to air disinfection under resource-limited conditions. Testing and treatment of latent TB infection works to prevent reactivatio...
Source: Clinics in Chest Medicine - November 13, 2019 Category: Respiratory Medicine Authors: Edward A. Nardell Source Type: research

New Drugs for the Treatment of Tuberculosis
Tuberculosis (TB) has now surpassed HIV as the leading infectious cause of death, and treatment success rates are declining. Multidrug-resistant TB, extensively drug-resistant TB, and even totally drug-resistant TB threaten to further destabilize disease control efforts. The second wave in TB drug development, which includes the diarylquinoline, bedaquiline, and the nitroimidazoles delamanid and pretomanid, may offer options for simpler, shorter, and potentially all-oral regimens to treat drug-resistant TB. The “third wave” of TB drug development includes numerous promising compounds, including less toxic versi...
Source: Clinics in Chest Medicine - November 13, 2019 Category: Respiratory Medicine Authors: Elisa H. Ignatius, Kelly E. Dooley Source Type: research

Treatment of Drug-Resistant Tuberculosis
This article provides an overview of the latest published strategies for clinical and programmatic management of drug-resistant TB. (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - November 13, 2019 Category: Respiratory Medicine Authors: Sundari R. Mase, Terence Chorba Source Type: research

Management of Children with Tuberculosis
Children carry a significant tuberculosis disease burden in settings with poor epidemic control and high levels of transmission. Even in high-resource settings, the diagnosis of tuberculosis in children can be challenging, but an accurate diagnosis can be achieved by adopting a systematic approach. This review outlines the general principles of tuberculosis prevention in children, including epidemic control, infection control, contact tracing and preventive therapy, and vaccination; diagnosing pediatric tuberculosis, including specimen collection and microbiological confirmation, highlighting key differences from adults; a...
Source: Clinics in Chest Medicine - November 13, 2019 Category: Respiratory Medicine Authors: Ameneh Khatami, Philip N. Britton, Ben J. Marais Source Type: research

Tuberculosis
Caused by Mycobacterium tuberculosis, tuberculosis (TB) remains a leading cause of infectious disease morbidity and mortality worldwide. In 2017, there were 10 million cases and 1.6 million deaths. The impact of TB is particularly harsh on vulnerable populations, such as children and those with human immunodeficiency virus, and its importance to global health is highlighted by the inclusion of the goal of ending TB in the Sustainable Development Goals, and by the first United Nations high-level meeting on TB that we held in September 2018. (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - November 13, 2019 Category: Respiratory Medicine Authors: David M. Lewinsohn, Charles L. Daley Tags: Preface Source Type: research

Tuberculosis
CLINICS IN CHEST MEDICINE (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - November 13, 2019 Category: Respiratory Medicine Authors: Charles L. Daley, David M. Lewinsohn Source Type: research

Copyright
ELSEVIER (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - November 13, 2019 Category: Respiratory Medicine Source Type: research

Contributors
DAVID M. LEWINSOHN, MD, PhD (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - November 13, 2019 Category: Respiratory Medicine Source Type: research

Contents
David M. Lewinsohn and Charles L. Daley (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - November 13, 2019 Category: Respiratory Medicine Source Type: research

Forthcoming Issues
Lung Cancer: Part I (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - November 13, 2019 Category: Respiratory Medicine Source Type: research

Interstitial Lung Disease in Polymyositis and Dermatomyositis
The idiopathic inflammatory myopathies (IIMs), including polymyositis (PM) and dermatomyositis (DM), are autoimmune connective tissue diseases with variable degrees of muscle inflammation and systemic involvement. Interstitial lung disease (ILD) is a common complication of the IIMs and is associated with increased mortality. Many patients with PM/DM have myositis-specific and myositis-associated antibodies (MSA/MAAs) that result in distinct clinical phenotypes. Among these MSAs, anti-aminoacyl-tRNA antibodies and anti-melanoma differentiation factor 5 antibodies have high rates of ILD. Corticosteroids are the mainstay of t...
Source: Clinics in Chest Medicine - August 1, 2019 Category: Respiratory Medicine Authors: Kathryn Long, Sonye K. Danoff Source Type: research

Immunoglobulin G4 –related Disease
Immunoglobulin G4 (IgG4) –Related Disease (IgG4-RD) can cause fibroinflammatory lesions in nearly any organ and lead to organ dysfunction and irreversible damage. In addition to frequent involvement of the salivary glands, lacrimal glands, and/or pancreas, IgG4-RD often affects the chest. Thoracic manifestations include l ung nodules and consolidations, pleural thickening, aortitis, and lymphadenopathy. The diagnosis is made after careful clinicopathologic correlation because there is no single diagnostic test with excellent sensitivity or specificity. Biopsy of pulmonary lesions can be useful for distinguishing IgG4...
Source: Clinics in Chest Medicine - August 1, 2019 Category: Respiratory Medicine Authors: Zachary S. Wallace, Cory Perugino, Mark Matza, Vikram Deshpande, Amita Sharma, John H. Stone Source Type: research

Interstitial Pneumonia with Autoimmune Features
The European Respiratory Society/American Thoracic Society Task Force on Undifferentiated Forms of Connective Tissue Disease-associated Interstitial Lung Disease put forth the research classification interstitial pneumonia with autoimmune features as a step toward uniformly describing these patients. Diverse nomenclature and classification schemes had been proposed to characterize them. This classification has provided uniform nomenclature and criteria, fostering interdisciplinary engagement and research. Longitudinal surveillance is needed; some patients evolve to a defined connective tissue disease. This review discusses...
Source: Clinics in Chest Medicine - August 1, 2019 Category: Respiratory Medicine Authors: Aryeh Fischer Source Type: research

Connective Tissue Disease –Associated Interstitial Lung Disease
Interstitial lung disease is common among patients with connective tissue disease and is an important contributor to morbidity and mortality. Infection and drug toxicity must always be excluded as the cause of radiographic findings. Immunosuppression remains a mainstay of therapy despite few controlled trials supporting its use. When a decision regarding therapy initiation is made, considerations include an assessment of disease severity as well as a determination of the rate of progression. Because patients may have extrathoracic disease activity, a multidisciplinary approach is crucial and should include supportive and n...
Source: Clinics in Chest Medicine - August 1, 2019 Category: Respiratory Medicine Authors: Danielle Antin-Ozerkis, Monique Hinchcliff Source Type: research

Lung Transplant in Patients with Connective Tissue Diseases
This article discusses the current data suggesting that clinical outcomes in patients with CTDs are similar to outcomes of patients who undergo lung transplant for idiopathic pulmonary fibrosis or chronic obstructive pulmonary disease. Larger studies focusing on the management of esophageal dysmotility and strategies of desensitization for increased antibody levels may result in approval of more patients with CTDs for lung transplant. (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - August 1, 2019 Category: Respiratory Medicine Authors: Tanmay S. Panchabhai, Hesham A. Abdelrazek, Ross M. Bremner Source Type: research

Pulmonary Pathology in Rheumatic Disease
The pathology of the pulmonary manifestations of rheumatoid diseases is characterized by its histologic heterogeneity and overlap with other pulmonary diseases. All anatomic compartments are vulnerable; thus, the morphologic changes vary according to the predominant region involved. Furthermore, the histologic patterns of injury are not unique to rheumatic diseases, given their resemblance to those seen in idiopathic forms, or in lung disease associated with other conditions. The patterns of interstitial lung disease, airway disorders, pleural processes, and vascular manifestations are described. The histopathology of sele...
Source: Clinics in Chest Medicine - August 1, 2019 Category: Respiratory Medicine Authors: Andrea V. Arrossi Source Type: research

Update on the Management of Respiratory Manifestations of the Antineutrophil Cytoplasmic Antibodies-Associated Vasculitides
This article outlines the major tracheobronchial and pulmonary parenchymal disease manifestations of GPA and MPA and their management, as well as relevant recent advances in the treatment of EGPA. Shared trends in the management of all 3 syndromes are: (1) a focus on glucocorticoid avoidance and (2) an increasing reliance on biologic agents. Evidence from randomized controlled trials and large cohort studies in support of these trends as well as ongoing research efforts are summarized. (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - August 1, 2019 Category: Respiratory Medicine Authors: Gwen E. Thompson, Ulrich Specks Source Type: research

Thoracic Manifestations of Rheumatic Disease
Rheum (n.): Watery or thin discharge of serum or mucus (fourteenth century)1Perhaps the etymologic background of rheumatology foretells the intimate relationship between diseases of the chest and rheumatologic disorders, a common cause of morbidity and mortality. Close collaboration between experts in both disciplines is essential in the comprehensive assessment and management of these complex patients. (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - August 1, 2019 Category: Respiratory Medicine Authors: Danielle Antin-Ozerkis, Kristin B. Highland Tags: Preface Source Type: research

Systemic Lupus Erythematosus and Antiphospholipid Antibody Syndrome
Systemic lupus erythematosus (SLE) is a systemic inflammatory disease, characterized by an antibody response to nucleic antigens and involvement of any organ system. Pulmonary manifestations are frequent and include pleuritis, acute lupus pneumonitis, chronic interstitial lung disease, alveolar hemorrhage, shrinking lung syndrome, airway disease, pulmonary hypertension (PH), and thromboembolic disease. The antiphospholipid antibody syndrome (APLAS) is a systemic autoimmune disorder where different prothrombotic factors interact to induce arterial and venous thrombosis. The most common pulmonary manifestations are pulmonary...
Source: Clinics in Chest Medicine - August 1, 2019 Category: Respiratory Medicine Authors: Maria Kokosi, Boris Lams, Sangita Agarwal Source Type: research

Autoimmune Biomarkers, Antibodies, and Immunologic Evaluation of the Patient with Fibrotic Lung Disease
This review summarizes the current state of knowledge on experimental and clinical biomarkers of autoimmunity and aims to highlight important aspects of the immunologic evaluation of a patient with fibrotic lung disease. (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - August 1, 2019 Category: Respiratory Medicine Authors: Argyris Tzouvelekis, Theodoros Karampitsakos, Evangelos Bouros, Vassilios Tzilas, Stamatis-Nick Liossis, Demosthenes Bouros Source Type: research

Thoracic Manifestations of Rheumatic Disease
CLINICS IN CHEST MEDICINE (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - August 1, 2019 Category: Respiratory Medicine Authors: Danielle Antin-Ozerkis, Kristin B. Highland Source Type: research

Copyright
ELSEVIER (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - August 1, 2019 Category: Respiratory Medicine Source Type: research

Contributors
DANIELLE ANTIN-OZERKIS, MD (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - August 1, 2019 Category: Respiratory Medicine Source Type: research

Contents
Danielle Antin-Ozerkis and Kristin B. Highland (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - August 1, 2019 Category: Respiratory Medicine Source Type: research

Forthcoming Issues
Tuberculosis (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - August 1, 2019 Category: Respiratory Medicine Source Type: research

Pulmonary Manifestations of Systemic Sclerosis and Mixed Connective Tissue Disease
Systemic sclerosis (SSc) is a rare disease characterized by widespread collagen deposition resulting in fibrosis. Although skin involvement is the most common manifestation and also the one that determines the classification of disease, mortality in SSc is usually a result of respiratory compromise in the form of interstitial lung disease (ILD) or pulmonary hypertension (PH). Clinically significant ILD is seen in up to 40% of patients and PH in up to 20%. Treatment with either cyclophosphamide or mycophenolate has been shown to delay disease progression, whereas rituximab and lung transplantation are reserved for refractor...
Source: Clinics in Chest Medicine - July 6, 2019 Category: Respiratory Medicine Authors: Apostolos Perelas, Andrea Valeria Arrossi, Kristin B. Highland Source Type: research

Pulmonary Involvement in Sj ögren Syndrome
Sj ögren syndrome (SS) is a progressive autoimmune disease characterized by dryness, predominantly of the eyes and mouth, caused by chronic lymphocytic infiltration of the lacrimal and salivary glands. Extraglandular inflammation can lead to systemic manifestations, many of which involve the lungs. St udies in which lung involvement is defined as requiring the presence of respiratory symptoms and either radiograph or pulmonary function test abnormalities quote prevalence estimates of 9% to 22%. The most common lung diseases that occur in relation to SS are airways disease and interstitial lung di sease. Evidence-based...
Source: Clinics in Chest Medicine - July 6, 2019 Category: Respiratory Medicine Authors: Jake G. Natalini, Chadwick Johr, Maryl Kreider Source Type: research

Thoracic Manifestations of Rheumatoid Arthritis
Rheumatoid arthritis (RA) is commonly associated with pulmonary disease that can affect any anatomic compartment of the thorax. The most common intrathoracic manifestations of RA include interstitial lung disease, airway disease, pleural disease, rheumatoid nodules, and drug-induced toxicity. Patients with RA with thoracic involvement often present with nonspecific respiratory symptoms, although many are asymptomatic. Therefore, clinicians should routinely consider pulmonary disease when evaluating any patient with RA, particularly one with known risk factors. The optimal screening, diagnostic, and treatment strategies for...
Source: Clinics in Chest Medicine - July 6, 2019 Category: Respiratory Medicine Authors: Anthony J. Esposito, Sarah G. Chu, Rachna Madan, Tracy J. Doyle, Paul F. Dellaripa Source Type: research

Thoracic Manifestations of Ankylosing Spondylitis, Inflammatory Bowel Disease, and Relapsing Polychondritis
Ankylosing spondylitis, inflammatory bowel disease (IBD), and relapsing polychondritis are immune-mediated inflammatory diseases with variable involvement of lungs, heart and the chest wall. Ankylosing spondylitis is associated with anterior chest wall pain, restrictive lung disease, obstructive sleep apnea, apical fibrosis, spontaneous pneumothorax, abnormalities of cardiac valves and conduction system, and aortitis. Patients with IBD can develop necrobiotic lung nodules that can be misdiagnosed as malignancy or infection. Relapsing polychondritis involves large airways in at least half of the patients. Relapsing polychon...
Source: Clinics in Chest Medicine - July 6, 2019 Category: Respiratory Medicine Authors: Abhijeet Danve Source Type: research

Imaging of the Thoracic Manifestations of Connective Tissue Disease
This article delineates the roles of CT in patients with CTD-related lung disease. (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - July 6, 2019 Category: Respiratory Medicine Authors: Brett M. Elicker, Kimberly G. Kallianos, Travis S. Henry Source Type: research

Update on Chemoreception
We examine recent findings that have revealed interdependence of function within the chemoreceptor pathway regulating breathing and sympathetic vasomotor activity and the hypersensitization of these reflexes in chronic disease states. Recommendations are made as to how these states of hyperreflexia in chemoreceptors and muscle afferents might be modified in treating sleep apnea, drug-resistant hypertension, chronic heart failure –induced sympathoexcitation, and the exertional dyspnea of chronic obstructive pulmonary disease. (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - May 9, 2019 Category: Respiratory Medicine Authors: Jerome A. Dempsey, Curtis A. Smith Source Type: research

Respiratory Determinants of Exercise Limitation
We examine 2 means by which the healthy respiratory system contributes to exercise limitation. These include the activation of respiratory and locomotor muscle afferent reflexes, which constrain blood flow and hasten fatigue in both sets of muscles, and the excessive increases in pulmonary vascular pressures at high cardiac outputs, which constrain O2 transport and precipitate maladaptive right ventricular remodeling in endurance-trained subjects. (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - May 9, 2019 Category: Respiratory Medicine Authors: Jerome A. Dempsey Source Type: research

Pulmonary Hypertension and Exercise
Cardiopulmonary exercise testing can be a useful tool for clinicians working with pulmonary hypertension (PH) patients. Exercise magnifies numerous cardiopulmonary decompensations, which can help inform diagnoses, assess degrees of physical impairment, evaluate exertional dyspnea, and estimate prognoses for PH patients. Supervised exercise training also holds promise in PH, because it is safe for patients and feasible and may improve key prognostic outcomes that relate to improvements in quality of life and survival. Still, few clinical trials have evaluated the potential therapeutic effects of exercise training, and futur...
Source: Clinics in Chest Medicine - May 9, 2019 Category: Respiratory Medicine Authors: James R. Vallerand, Jason Weatherald, Pierantonio Laveneziana Source Type: research

Physiologic Effects of Oxygen Supplementation During Exercise in Chronic Obstructive Pulmonary Disease
Supplemental long-term oxygen therapy (LTOT) is a well-established therapy that improves mortality in patients with chronic obstructive pulmonary disease (COPD) with resting hypoxemia. In the large number of patients with COPD who do not have severe resting hypoxemia but who desaturate with exercise, the clinical benefits that can be obtained by supplemental O2 therapy during exercise is an area of interest and active research. A summary of current evidence for benefits of supplemental O2 therapy and a review of physiologic mechanisms underlying published observations are reviewed in this article. (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - May 9, 2019 Category: Respiratory Medicine Authors: Asli Gorek Dilektasli, Janos Porszasz, William W. Stringer, Richard Casaburi Source Type: research

Incorporating Lung Diffusing Capacity for Carbon Monoxide in Clinical Decision Making in Chest Medicine
This article presents the physiologic and methodologic foundations of Dlco measurement. A clinically friendly approach for Dlco interpretation that takes those caveats into consideration is outlined. The clinical scenarios in which Dlco can effectively assist the chest physician are discussed and illustrative clinical cases are presented. (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - May 9, 2019 Category: Respiratory Medicine Authors: J. Alberto Neder, Danilo C. Berton, Paulo T. Muller, Denis E. O ’Donnell Source Type: research

Clinical and Physiologic Implications of Negative Cardiopulmonary Interactions in Coexisting Chronic Obstructive Pulmonary Disease-Heart Failure
Chronic obstructive pulmonary disease (COPD) and heart failure with reduced ejection fraction (HF) frequently coexist in the elderly. Expiratory flow limitation and lung hyperinflation due to COPD may adversely affect central hemodynamics in HF. Low lung compliance, increased alveolar-capillary membrane thickness, and abnormalities in pulmonary perfusion because of HF further deteriorates lung function in COPD. We discuss how those negative cardiopulmonary interactions create challenges in clinical interpretation of pulmonary function and cardiopulmonary exercise tests in coexisting COPD-HF. In the light of physiologic con...
Source: Clinics in Chest Medicine - May 9, 2019 Category: Respiratory Medicine Authors: J. Alberto Neder, Alcides Rocha, Danilo C. Berton, Denis E. O ’Donnell Source Type: research

The Pathophysiology of Dyspnea and Exercise Intolerance in Chronic Obstructive Pulmonary Disease
Dyspnea, the most common symptom in chronic obstructive pulmonary disease (COPD), often becomes disabling in advanced stages of the disease. Chronic dyspnea erodes perceived health status and diminishes engagement in physical activity, often leading to skeletal muscle deconditioning, anxiety, depression, and social isolation. Broader understanding of the pathophysiologic underpinnings of dyspnea has allowed us to formulate a sound rationale for individualized management. This review examines recent research and provides historical context. The overarching objectives are to consider current constructs of the physiologic mec...
Source: Clinics in Chest Medicine - May 9, 2019 Category: Respiratory Medicine Authors: Denis E. O ’Donnell, Matthew D. James, Kathryn M. Milne, J. Alberto Neder Source Type: research