Clustering of immune-mediated diseases in sarcoidosis
Purpose of review Sarcoidosis is an immune-mediated disease of unknown cause. Immune-mediated diseases appear to cluster in patients and in families. We review what is known on this topic for sarcoidosis, and what factors may underlie disease clustering. Recent findings In populations of patients with sarcoidosis, relative risk estimates of Sjögren's syndrome, systemic lupus erythematosus, autoimmune hepatitis, ankylosing spondylitis, multiple sclerosis (MS), celiac disease, autoimmune thyroid disease, and ulcerative colitis, varied between 2.1 and 11.6. In relatives of patients with sarcoidosis, relative risk es...
Source: Current Opinion in Pulmonary Medicine - August 2, 2019 Category: Respiratory Medicine Tags: SARCOIDOSIS: Edited by Jan C. Grutters and Marc A. Judson Source Type: research

Nonorgan manifestations of sarcoidosis
Purpose of review The current review discusses the diagnosis and management of nonorgan-related symptoms that commonly arise in the setting of systemic sarcoidosis. Fatigue, small fiber neuropathy (SFN) and neuropsychological symptoms are highlighted. Recent findings The debilitating effects of chronic nonorgan-based symptoms in sarcoidosis have led to recent studies focusing on incidence rates, contributing factors and potential therapeutic strategies. In a web-based survey of over 1000 sarcoidosis patients, the most common symptom was fatigue, which was reported by over 90% of participants, whereas memory loss and c...
Source: Current Opinion in Pulmonary Medicine - August 2, 2019 Category: Respiratory Medicine Tags: SARCOIDOSIS: Edited by Jan C. Grutters and Marc A. Judson Source Type: research

Approach to tapering antisarcoidosis therapy
Purpose of review Sarcoidosis is a multisystemic granulomatous disease, which commonly affects the lung. The natural course of the disease and prognosis are variable from asymptomatic, spontaneous remission to progressive disease, which requires treatment. Once treatment is initiated, tapering therapy can be problematic. Recent findings Corticosteroids are recommended as first-line therapy, but optimal regimen and duration of treatment is not well established. Treatment may differ based on severity of disease, extrapulmonary involvement, physician and patient preferences. We reviewed currently recommended regimens, pa...
Source: Current Opinion in Pulmonary Medicine - August 2, 2019 Category: Respiratory Medicine Tags: SARCOIDOSIS: Edited by Jan C. Grutters and Marc A. Judson Source Type: research

Treatment of cardiac sarcoidosis
Purpose of review In sarcoidosis, the appropriate management strategy remains challenging especially because of the lack of confident diagnosis, considerable variability in initial presentation, disease evolution, and outcome. Although asymptomatic patients with limited cardiac involvement have been described to have a benign outcome, cardiac sarcoidosis is associated with high morbidity and mortality and even sudden cardiac death in a significant proportion of patients. Higher morbidity and mortality can be related with both the disease activity and extent of fibrosis. Recent findings Historical series suggested a 5-...
Source: Current Opinion in Pulmonary Medicine - August 2, 2019 Category: Respiratory Medicine Tags: SARCOIDOSIS: Edited by Jan C. Grutters and Marc A. Judson Source Type: research

Indications for treatment of sarcoidosis
Purpose of review To describe the current knowledge on indications for sarcoidosis treatment. Recent findings Despite the lack of evidence-based recommendations, the sarcoidosis community has adopted the concept of starting systemic anti-inflammatory treatment because of potential danger (risk of severe dysfunction on major organs or death) or unacceptable impaired quality of life (QoL). On the contrary, while QoL and functionality are patients’ priorities, few studies have evaluated treatment effect on patient-reported outcomes. The awareness of long-term corticosteroids toxicities and consequences on QoL and t...
Source: Current Opinion in Pulmonary Medicine - August 2, 2019 Category: Respiratory Medicine Tags: SARCOIDOSIS: Edited by Jan C. Grutters and Marc A. Judson Source Type: research

Advanced sarcoidosis
Purpose of review Advanced sarcoidosis is an important cause of morbidity and mortality in sarcoidosis. Over the past few years, several studies have been published clarifying the prevalence and severity of this condition. Recent findings Pulmonary involvement is the most common form of sarcoidosis. Increased morbidity and significant mortality is encountered in advanced lung disease. Although many sarcoidosis patients with pulmonary fibrosis have a normal life expectancy, at least 20% develop progression and may die from this complication. Sarcoidosis-associated pulmonary hypertension (SAPH) is an independent cause o...
Source: Current Opinion in Pulmonary Medicine - August 2, 2019 Category: Respiratory Medicine Tags: SARCOIDOSIS: Edited by Jan C. Grutters and Marc A. Judson Source Type: research

The diagnosis of sarcoidosis
Purpose of review To review the diagnostic approach to sarcoidosis. There is no gold standard diagnostic test, procedure or algorithm for sarcoidosis. The diagnosis is based on a compatible clinical presentation, histologic findings of granulomatous inflammation, exclusion of alternative diseases, and evidence of systemic involvement. Occasionally, there may be exceptions to several of these requirements. Recent findings The diagnostic specificity of several specific clinical features are discussed. Typical histologic findings of sarcoidosis are described. Several diseases that may mimic sarcoidosis are reviewed. Sum...
Source: Current Opinion in Pulmonary Medicine - August 2, 2019 Category: Respiratory Medicine Tags: SARCOIDOSIS: Edited by Jan C. Grutters and Marc A. Judson Source Type: research

Patient perspectives in sarcoidosis
Purpose of review The review presents an overview of the scientific publications about patient perspectives in sarcoidosis. Recent findings The literature on patient perspectives in sarcoidosis is limited. Patient perspectives in sarcoidosis encompass a myriad of topics that have been addressed to some degree in the literature: patient needs and perceptions, patient-reported burden of sarcoidosis, and patient treatment priorities. Similar findings across studies were high levels of reported fatigue, a need to incorporate psychological support into the treatment plan and easy access to sarcoidosis expert centers. Furth...
Source: Current Opinion in Pulmonary Medicine - August 2, 2019 Category: Respiratory Medicine Tags: SARCOIDOSIS: Edited by Jan C. Grutters and Marc A. Judson Source Type: research

Drug-induced interstitial lung disease: role of pharmacogenetics in predicting cytotoxic mechanisms and risks of side effects
Purpose of review The diagnosis of drug-induced interstitial lung disease (DI-ILD) is challenging and mainly made by exclusion of other possible causes. Toxicity can occur as a cause of drug(s) or drug–drug interactions. In this review, we summarize the possible role of pharmacogenetics of metabolizing enzymes in DI-ILD. Recent findings Knowledge of the genetic predispositions of enzymes involved in drug metabolization and their relation with proposed cytotoxic mechanisms of DI-ILD, in particular direct cell toxicity and free oxygen radical production is increasing. The cytochrome P450 enzyme family and other en...
Source: Current Opinion in Pulmonary Medicine - August 2, 2019 Category: Respiratory Medicine Tags: INTERSTITIAL LUNG DISEASE: Edited by Francesco Bonella and Paolo Spagnolo Source Type: research

Pulmonary hypertension due to interstitial lung disease
Purpose of review Pulmonary hypertension has been reported to complicate the course of a number of fibrotic lung diseases, including idiopathic pulmonary fibrosis, chronic hypersensitivity pneumonitis and nonspecific interstitial pneumonitis. Most commonly, mild elevations in the mean pulmonary artery pressure are seen in patients with advanced pulmonary fibrosis. However, some patients may develop severe pulmonary hypertension, which appears out of proportion to the degree of their restrictive lung disease. Recent findings The benefits of pulmonary vasodilator therapy have yet to be established in pulmonary hypertens...
Source: Current Opinion in Pulmonary Medicine - August 2, 2019 Category: Respiratory Medicine Tags: INTERSTITIAL LUNG DISEASE: Edited by Francesco Bonella and Paolo Spagnolo Source Type: research

Shaping the future of an ultra-rare disease: unmet needs in the diagnosis and treatment of pulmonary alveolar proteinosis
We report on novel therapeutic approaches such as GM-CSF substitution, stem cell transplantation, pioglitazone, statins and immunomodulation. Recent findings The discovery of new genetic mutations underlying this syndrome raises the question whether the classification should be radically revised in the future. Serum GM-CSF autoantibody is the best diagnostic marker for autoimmune PAP, the most common form, but does not correlate with disease severity. Several circulating biomarkers have been investigated to assess disease activity and predict outcome. Imaging techniques have also enormously evolved and offer new tools t...
Source: Current Opinion in Pulmonary Medicine - August 2, 2019 Category: Respiratory Medicine Tags: INTERSTITIAL LUNG DISEASE: Edited by Francesco Bonella and Paolo Spagnolo Source Type: research

New trajectories in the treatment of interstitial lung disease: treat the disease or treat the underlying pattern?
Purpose of review A subset of patients with interstitial lung diseases (ILDs), such as rheumatoid arthritis (RA)-associated ILD and chronic hypersensitivity pneumonitis, will experience a disease course similar to patients with idiopathic pulmonary fibrosis (IPF). They also often have a usual interstitial pneumonia (UIP) pattern of fibrosis. Although the standard of care for patients with RA-ILD and chronic hypersensitivity pneumonitis is immunosuppression, the optimal treatment for patients with progressive disease and a UIP pattern remains unknown. Recent findings Recent research has highlighted shared risk factors,...
Source: Current Opinion in Pulmonary Medicine - August 2, 2019 Category: Respiratory Medicine Tags: INTERSTITIAL LUNG DISEASE: Edited by Francesco Bonella and Paolo Spagnolo Source Type: research

Critical reappraisal of underlying histological patterns in patients with suspected idiopathic pulmonary fibrosis
Purpose of review Usual interstitial pneumonia (UIP) pattern is the histologic marker of idiopathic pulmonary fibrosis (IPF), but usefulness of ancillary histologic findings may discriminate idiopathic from secondary UIP. Recent findings Alternative less invasive procedures may identify UIP pattern preventing conventional surgical lung biopsy, whereas genomic analysis may recognize UIP pattern from otherwise poorly diagnostic samples. Summary High-resolution computed tomography identifies a ‘definite’ UIP pattern in about half of cases, failing to recognize UIP in the absence of honeycombing or in limit...
Source: Current Opinion in Pulmonary Medicine - August 2, 2019 Category: Respiratory Medicine Tags: INTERSTITIAL LUNG DISEASE: Edited by Francesco Bonella and Paolo Spagnolo Source Type: research

Visual vs. computer-based computed tomography analysis for the identification of functional patterns in interstitial lung diseases
Purpose of review Computer algorithms possess an intrinsic speed, objectivity, reproducibility and scalability unmatched by visual quantitation methods performed by trained readers. The question of how well quantitative CT (QCT) analysis methods compare with visual CT analysis to predict functional status in fibrosing lung diseases (FLDs) is of increasing relevance to understand the future role QCT may have in prognostication of FLD. Recent findings The latest computer algorithms demonstrate improved performance over visual CT analysis in predicting baseline disease severity as measured by correlations with functional...
Source: Current Opinion in Pulmonary Medicine - August 2, 2019 Category: Respiratory Medicine Tags: INTERSTITIAL LUNG DISEASE: Edited by Francesco Bonella and Paolo Spagnolo Source Type: research

Abandoning developmental silos: what can paediatricians and adult interstitial lung disease physicians learn from each other?
Purpose of review Interstitial lung disease (ILD) consists of a large and heterogeneous group of disorders that are classified together because of similar clinical, radiographic, physiologic or pathologic manifestations. Overall, although there is overlap between adult and childhood ILD (chILD), there are many differences in disease causes and prevalences. Recent findings In the last few years, our understanding of adult ILD pathobiology has improved substantially. This is particularly true for idiopathic pulmonary fibrosis, the most common of the idiopathic interstitial pneumonias, wherein recently developed guidelin...
Source: Current Opinion in Pulmonary Medicine - August 2, 2019 Category: Respiratory Medicine Tags: INTERSTITIAL LUNG DISEASE: Edited by Francesco Bonella and Paolo Spagnolo Source Type: research

The right treatment for the right ventricle
Purpose of review Right ventricular (RV) function is an important determinant of morbidity and mortality in patients with pulmonary arterial hypertension (PAH). Although substantial progress has been made in understanding the development of RV failure in the last decennia, this has not yet resulted in the development of RV selective therapies. In this review, we will discuss the current status on the treatment of RV failure and potential novel therapeutic strategies that are currently being investigated in clinical trials. Recent findings Increased afterload results in elevated wall tension. Consequences of increased ...
Source: Current Opinion in Pulmonary Medicine - August 2, 2019 Category: Respiratory Medicine Tags: DISORDERS OF THE PULMONARY CIRCULATION: Edited by Richard Channick and Anton Vonk Noordegraaf Source Type: research

Malnutrition in pulmonary arterial hypertension: a possible role for dietary intervention
Purpose of review The last decade's progress has been made in the pharmacological treatment of pulmonary arterial hypertension (PAH). The role of nutrition in relation to quality of life in this group of patients is not investigated yet. In addition to avoiding salt and high-fluid intake based on left heart failure diet, there is no evidence-based diet recommendation for PAH. Recent findings It was recently demonstrated that patients with PAH suffer from malnutrition resulting in iron and vitamin D deficiency and glucose/insulin resistance. Recent experimental studies suggest that besides reduced malabsorption of impo...
Source: Current Opinion in Pulmonary Medicine - August 2, 2019 Category: Respiratory Medicine Tags: DISORDERS OF THE PULMONARY CIRCULATION: Edited by Richard Channick and Anton Vonk Noordegraaf Source Type: research

The role of rehabilitation in patients with pulmonary arterial hypertension
Purpose of review The current review summarizes the latest evidence of the effects of exercise training for pulmonary hypertension patients demonstrated by six randomized controlled trails and 20 further studies. As the availability of exercise training is still limited it is important to raise awareness of the body of evidence showing the benefit for the patients and the limitations. Recent findings The effects of exercise training on exercise capacity, hemodynamics as well as quality of life are described as well as different settings and components of exercise training. Associated adverse events are critically revi...
Source: Current Opinion in Pulmonary Medicine - August 2, 2019 Category: Respiratory Medicine Tags: DISORDERS OF THE PULMONARY CIRCULATION: Edited by Richard Channick and Anton Vonk Noordegraaf Source Type: research

The global view
Purpose of review To understand the global distribution of different forms of pulmonary hypertension. Recent findings Different registries have explored the epidemiological characteristics of pulmonary hypertension. Interestingly, there is a clear difference in the prevalence of different forms of pulmonary hypertension in developed regions in comparison with less developed countries. This finding suggests not only that extrapolation of data should be avoided but also that the known prevalence of pulmonary hypertension might be underestimated. Summary Pulmonary hypertension might be more prevalent than what is curr...
Source: Current Opinion in Pulmonary Medicine - August 2, 2019 Category: Respiratory Medicine Tags: DISORDERS OF THE PULMONARY CIRCULATION: Edited by Richard Channick and Anton Vonk Noordegraaf Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Pulmonary Medicine)
Source: Current Opinion in Pulmonary Medicine - August 2, 2019 Category: Respiratory Medicine Tags: EDITORIAL INTRODUCTIONS Source Type: research

Pleural effusion related to IgG4
Purpose of review The causes of exudative pleural effusions are diverse and frequently remain unclear despite exhaustive examinations. Recently recognized IgG4-related disease (IgG4-RD) is a fibroinflammatory disorder that can affect nearly any organ including the lungs. This review will focus on the involvement of IgG4 in exudative pleural effusion of unknown cause. Recent findings IgG4 is found to be involved in a proportion of patients with undiagnosed pleural effusions. Pleural involvement in IgG4-RD can be seen in isolation or association with other organ disease. Pleural thickening and/or effusion are common cli...
Source: Current Opinion in Pulmonary Medicine - June 8, 2019 Category: Respiratory Medicine Tags: DISEASES OF THE PLEURA: Edited by Richard Light Source Type: research

Outpatient talc administration via indwelling pleural catheters for malignant effusions
Purpose of review Malignant pleural effusion is a common cause of breathlessness and signifies advanced disease. Common options for definitive pleural intervention include insertion of an indwelling pleural catheter (IPC) or talc pleurodesis. Recent findings Administration of graded talc through an IPC offers an increased chance of pleurodesis compared with IPC drainage alone and is not associated with a significant risk of adverse events. Summary In patients where an ambulatory treatment pathway is preferred, the increased chance of pleurodesis with talc administration via IPC can result in a faster time to device...
Source: Current Opinion in Pulmonary Medicine - June 8, 2019 Category: Respiratory Medicine Tags: DISEASES OF THE PLEURA: Edited by Richard Light Source Type: research

Particle size, distribution, and behavior of talc preparations: within the United States and beyond
Purpose of review Talc remains a common sclerosant utilized for pleurodesis. However, the use of talc has documented complications and debate has persisted regarding the safety of talc as well as the differences in talc preparations available throughout the world. We sought to describe an up-to-date review of talc preparations available and the impact these preparations may have on the safety profile of talc. Recent findings Within laboratory-based examinations, talc particle size available within the United States appears to be more consistent with prior reported ‘safe’ particle sizes. The presence of tal...
Source: Current Opinion in Pulmonary Medicine - June 8, 2019 Category: Respiratory Medicine Tags: DISEASES OF THE PLEURA: Edited by Richard Light Source Type: research

Indwelling pleural catheters for benign pleural effusions: what is the evidence?
Purpose of review Benign pleural effusions are common and usually managed by treating the underlying disease process. In some patients, these effusions may be refractory to medical management. Indwelling pleural catheters, used extensively for malignant pleural effusions, are increasingly used in benign pleural effusions not responding to medical therapy. This review focuses on current data regarding their safety and effectiveness in effusions due to congestive heart failure, hepatic hydrothorax, end-stage renal disease, and chylothorax. Recent findings Indwelling pleural catheters are effective and appear well tolera...
Source: Current Opinion in Pulmonary Medicine - June 8, 2019 Category: Respiratory Medicine Tags: DISEASES OF THE PLEURA: Edited by Richard Light Source Type: research

Diagnosis and characterization of malignant effusions through pleural fluid cytological examination
Purpose of review Malignancy accounts for a substantial proportion of pleural effusions, and cytologic examination of pleural fluid is the easiest way to establish the diagnosis. This review summarizes relevant advances in the diagnostic cytopathology of pleural effusions for the practicing pulmonologist. Recent findings Cytologic analysis using a stained smear and cell block preparation is able to provide the diagnosis in about 55% of malignant effusions. Processing a maximum of two separate specimens (provided the initial examination is negative) with an approximate volume of 40 ml each is the most accepted recomm...
Source: Current Opinion in Pulmonary Medicine - June 8, 2019 Category: Respiratory Medicine Tags: DISEASES OF THE PLEURA: Edited by Richard Light Source Type: research

Advances in pathological diagnosis of mesothelioma: what pulmonologists should know
Purpose of review Malignant pleural mesothelioma (MPM) is a universally fatal illness with a rising incidence, particularly in developing countries. The diagnosis can be challenging and require repeated investigations with implications for the patient and healthcare system. Recent findings Distinguishing between benign/reactive and malignant mesothelial proliferations can be challenging. Cytological diagnosis of MPM from pleural fluid is as reliable as histological analysis of tissue biopsies in epithelioid MPM – an approach endorsed by the International Academy of Cytology. Identification of BRCA1-associated pr...
Source: Current Opinion in Pulmonary Medicine - June 8, 2019 Category: Respiratory Medicine Tags: DISEASES OF THE PLEURA: Edited by Richard Light Source Type: research

Management of the solitary pulmonary nodule
Purpose of review We review the categorization and management of solitary pulmonary nodules. Recent findings The National Comprehensive Cancer Network guidelines were updated in 2018 and the revised Fleischner Society guidelines were published in 2017. The revised Fleischner Society guidelines published in 2017 have less frequent follow-up recommendations for incidentally detected pulmonary nodules with longer intervals between subsequent CT scans. The updated 2018 version of National Comprehensive Cancer Network lung cancer screening guidelines provide recommendations for screen-detected nodules based on a patient's ...
Source: Current Opinion in Pulmonary Medicine - June 8, 2019 Category: Respiratory Medicine Tags: NEOPLASMS OF THE LUNG WITH IMAGING: Edited by Alan M. Fein and David E. Ost Source Type: research

Tracheal tumors
This article provides the most recent literature and experienced guidance about diagnosis and management of tracheal tumors, including future directions. Recent findings Tracheal tumors are challenging to diagnose given their nonspecific and late-onset symptoms. Critical airway obstruction is the most feared complication. The cornerstone in management of them is surgical resection whenever is possible. Different diagnostic tests (i.e., imaging and bronchoscopy) help in the assessment of resectability. Alternative management including interventional bronchoscopic techniques can be offered to patients who are not suitable...
Source: Current Opinion in Pulmonary Medicine - June 8, 2019 Category: Respiratory Medicine Tags: NEOPLASMS OF THE LUNG WITH IMAGING: Edited by Alan M. Fein and David E. Ost Source Type: research

Nonresolving pneumonia in the setting of malignancy
This article reviews recent literature and experience in the diagnosis of nonresolving and slowly resolving pneumonia as it pertains to malignancy. Recent findings Malignancy must be considered as an important cause of pneumonia that resolves slowly or has incomplete resolution. Airway obstruction is more common than malignant infiltration as a cause of pneumonia that does not resolve appropriately. Infection due to resistant or unusual organisms must also be considered in the differential diagnosis. Summary Nonresolving pneumonia remains an important clinical challenge. Bronchoscopic evaluation in conjunction with c...
Source: Current Opinion in Pulmonary Medicine - June 8, 2019 Category: Respiratory Medicine Tags: NEOPLASMS OF THE LUNG WITH IMAGING: Edited by Alan M. Fein and David E. Ost Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Pulmonary Medicine)
Source: Current Opinion in Pulmonary Medicine - June 8, 2019 Category: Respiratory Medicine Tags: EDITORIAL INTRODUCTIONS Source Type: research

Genetics in community-acquired pneumonia
Purpose of review Host defense against community-acquired pneumonia depends on an intact innate and acquired immune system. This review analyses the correlation between specific defects and polymorphisms of immunity genes with susceptibility for pneumonia. Recent findings Mutations in BTK, Bruton's tyrosine kinase, lead to X-linked agammaglobulinemia, a disease characterized by recurrent respiratory tract infections, including pneumonia. BTK inhibitors, which are used for treatment of leukemia, have pneumonia as side effect. Polymorphisms in B lymphocyte growth and differentiation factors, including IL-6 and IL-10, Fc...
Source: Current Opinion in Pulmonary Medicine - March 29, 2019 Category: Respiratory Medicine Tags: GENETICS: Edited by Coline H.M. van Moorsel Source Type: research

Genetic profiling for disease stratification in chronic obstructive pulmonary disease and asthma
Purpose of review In asthma and chronic obstructive pulmonary disease (COPD), the movement towards genetic profiling with a push towards ‘personalized medicine’ has been hindered by complex environment--gene interactions and lack of tools to identify clear causal genetic traits. In this review, we will discuss the need for genetic profiling in asthma and COPD, what methods are currently used in the clinics and the recent finding using new sequencing methods. Recent findings Over the past 10–15 years, genome-wide association studies analysis of common variants has provide little in the way of new gene...
Source: Current Opinion in Pulmonary Medicine - March 29, 2019 Category: Respiratory Medicine Tags: GENETICS: Edited by Coline H.M. van Moorsel Source Type: research

Precision medicine: integration of genetics and functional genomics in prediction of bronchiolitis obliterans after lung transplantation
Purpose of review Lung transplantation (LTx) can be a life saving treatment in end-stage pulmonary diseases, but survival after transplantation is still limited. Posttransplant development of chronic lung allograft dysfunction with bronchiolits obliterans syndrome (BOS) as the major subphenotype, is the main cause of morbidity and mortality. Early identification of high-risk patients for BOS is a large unmet clinical need. In this review, we discuss gene polymorphisms and gene expression related to the development of BOS. Recent findings Candidate gene studies showed that donor and recipient gene polymorphisms affect ...
Source: Current Opinion in Pulmonary Medicine - March 29, 2019 Category: Respiratory Medicine Tags: GENETICS: Edited by Coline H.M. van Moorsel Source Type: research

Treatment of oncogene-driven non-small cell lung cancer
Purpose of review With the development of targeted therapies, the treatment strategy of patients with advanced or metastatic non-small cell lung cancer (NSCLC) has changed tremendously. In this review, we focus on the different aspects of the treatment of oncogene-driven NSCLC. Recent findings Patients with an EGFR or ALK alteration show a better clinical outcome with tyrosine kinase inhibitor (TKI) treatment compared to chemotherapy. Patients with a ROS1 rearrangement or a BRAF V600E mutation show favorable clinical outcome with TKI treatment compared to chemotherapy, although randomized trials are not available. P...
Source: Current Opinion in Pulmonary Medicine - March 29, 2019 Category: Respiratory Medicine Tags: GENETICS: Edited by Coline H.M. van Moorsel Source Type: research

The influence of genetics on therapeutic developments in pulmonary alveolar proteinosis
Purpose of review Pulmonary alveolar proteinosis (PAP) is characterized by the massive accumulation of lipoproteinaceous material within alveoli, which results in progressive respiratory failure. The abnormalities in surfactant clearance are caused by defective pulmonary macrophages, whose terminal differentiation is GM-CSF-dependent. In hereditary PAP, the rupture of GM-CSF signaling is because of mutations in the GM-CSF receptor genes. This review focus on the innovative technologies of gene-correction proposed for the development of new therapeutic strategies, for hereditary PAP patients. Recent findings Hematopoie...
Source: Current Opinion in Pulmonary Medicine - March 29, 2019 Category: Respiratory Medicine Tags: GENETICS: Edited by Coline H.M. van Moorsel Source Type: research

Inhaled antibiotics for the treatment of pneumonia
Purpose of review To describe recent developments in trials exploring inhaled antibiotics for treating severe pneumonia. Recent findings Three recent randomized studies investigated the potential role for aerosolized antibiotics for gram-negative pneumonia in ventilated patients. One single center, nonblinded investigation suggested a benefit with inhaled amikacin for resistant gram-negative infections. However, two multicenter, blinded trials found no benefit to adjunctive nebulized amikacin for severe gram-negative pneumonia. Summary Well done clinical trials do not support the routine use of inhaled amikacin for...
Source: Current Opinion in Pulmonary Medicine - March 29, 2019 Category: Respiratory Medicine Tags: INFECTIOUS DISEASES: Edited by Michael S. Niederman and Alimuddin Zumla Source Type: research

Bronchiectasis phenotypes
Purpose of review Bronchiectasis is a chronic respiratory disease with heterogeneous clinical manifestations and outcomes. Identifying clinical phenotypes could help in managing bronchiectasis patients and hopefully improve disease prognosis by adopting personalized treatment. We review the current literature on clinical phenotypes of bronchiectasis and try to highlight priorities for future research. Recent findings Different studies have tried to stratify bronchiectasis patients according to cause, microbiology, or associated conditions. In consideration of the huge heterogeneity of bronchiectasis different cluster ...
Source: Current Opinion in Pulmonary Medicine - March 29, 2019 Category: Respiratory Medicine Tags: INFECTIOUS DISEASES: Edited by Michael S. Niederman and Alimuddin Zumla Source Type: research

New drugs to treat difficult tuberculous and nontuberculous mycobacterial pulmonary disease
Purpose of review Treatment of drug-sensitive tuberculosis (TB) is effective, whereas that of multidrug-resistant and extensively drug-resistant TB as well as nontuberculous mycobacterial (NTM) disease are less so. Therapy in general requires good adherence to potentially toxic drug regimens over prolonged periods. Poor adherence is associated with resistance development and poor outcome. This review will present promising new treatments, both new drugs and regimens, for difficult mycobacterial pulmonary infections. Recent findings A number of new and repurposed drugs including bedaquiline, delamanid, pretomanid, line...
Source: Current Opinion in Pulmonary Medicine - March 29, 2019 Category: Respiratory Medicine Tags: INFECTIOUS DISEASES: Edited by Michael S. Niederman and Alimuddin Zumla Source Type: research

Comparing current US and European guidelines for nosocomial pneumonia
Purpose of review In the last 2 years, two major guidelines for the management of nosocomial pneumonia have been published: The International European Respiratory Society/European Society of Intensive Care Medicine/European Society of Clinical Microbiology and Infectious Diseases/Asociación Latinoamericana de Toráx guidelines for the management of hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) and the American guidelines for management of adults with HAP and VAP; both the guidelines made important clinical recommendations for the management of patients. Recent findings With t...
Source: Current Opinion in Pulmonary Medicine - March 29, 2019 Category: Respiratory Medicine Tags: INFECTIOUS DISEASES: Edited by Michael S. Niederman and Alimuddin Zumla Source Type: research

Cardiovascular sequelae of pneumonia
Purpose of review In this brief review, we discuss the current epidemiological data and latest results from basic research on the cardiovascular sequelae after lower respiratory tract infection. Recent findings Novel epidemiological evidence substantiates the association between pneumonia and subsequent cardiovascular events (CVEs) in the short- and long-term after viral or bacterial acute infection. Biomarkers such as cardiac troponin or coronary artery calcium may represent useful predictive tools for the detection of cardiac involvement during and after pneumonia. Particularly, Streptococcus pneumoniae directly cau...
Source: Current Opinion in Pulmonary Medicine - March 29, 2019 Category: Respiratory Medicine Tags: INFECTIOUS DISEASES: Edited by Michael S. Niederman and Alimuddin Zumla Source Type: research

Outpatient management of community-acquired pneumonia
Purpose of review Although most patients with community-acquired pneumonia (CAP) are treated as outpatients, the majority of data regarding CAP management is provided by hospitals, either from emergency department or inpatients. This was already noted in the first CAP guidelines, published in 1993, and the challenges regarding the outpatient management of CAP persist nowadays. These include the uncertainty of the initial diagnosis and risk stratification, the empirical choice of antibiotics, the overgrowing of antibiotic resistance bacteria and the relative scarcity of novel antibiotics. Recent findings New molecular ...
Source: Current Opinion in Pulmonary Medicine - March 29, 2019 Category: Respiratory Medicine Tags: INFECTIOUS DISEASES: Edited by Michael S. Niederman and Alimuddin Zumla Source Type: research

Computed tomography scan contribution to the diagnosis of community-acquired pneumonia
Purpose of review Pneumonia is a frequent disease mainly affecting older and multimorbid patients. Symptoms and signs lack sensitivity and specificity, and chest X-ray has poor accuracy. Hence, an initial diagnosis of pneumonia has limited predictive value for the presence of pneumonia. Overdiagnosis of pneumonia leads to inappropriate antibiotic use and may delay the appropriate management of mimicking diseases. Alternative imaging strategies including computed tomography (CT)-scan or lung ultrasonography may improve the diagnosis of pneumonia. We review the recent evidence and perspectives regarding their contribution ...
Source: Current Opinion in Pulmonary Medicine - March 29, 2019 Category: Respiratory Medicine Tags: INFECTIOUS DISEASES: Edited by Michael S. Niederman and Alimuddin Zumla Source Type: research

Precision medicine in the clinical management of respiratory tract infections including multidrug-resistant tuberculosis: learning from innovations in immuno-oncology
Purpose of review In the light of poor management outcomes of antibiotic-resistant respiratory tract infection (RTI)-associated sepsis syndrome and multidrug-resistant tuberculosis (MDR-TB), new management interventions based on host-directed therapies (HDTs) are warranted to improve morbidity, mortality and long-term functional outcomes. We review developments in potential HDTs based on precision cancer therapy concepts applicable to RTIs including MDR-TB. Recent findings Immune reactivity, tissue destruction and repair processes identified during studies of cancer immunotherapy share common pathogenetic mechanisms w...
Source: Current Opinion in Pulmonary Medicine - March 29, 2019 Category: Respiratory Medicine Tags: INFECTIOUS DISEASES: Edited by Michael S. Niederman and Alimuddin Zumla Source Type: research

Necrotizing pneumonia (aetiology, clinical features and management)
Purpose of review Necrotizing pneumonia is a severe form of community-acquired pneumonia characterized by rapid progression of consolidation to necrosis and cavitation which may lead to pulmonary gangrene. Morbidity and mortality are high and chronic sequelae are frequent. The lack of guidance supports the review of the latest recommendations in the management of these pneumonias. Recent findings Antibiotic therapy alone may not be enough to alter the course of the infection, and regimens, adjunctive therapies like intravenous immunoglobulins, surgery may be required to alter the course of the disease especially with ...
Source: Current Opinion in Pulmonary Medicine - March 29, 2019 Category: Respiratory Medicine Tags: INFECTIOUS DISEASES: Edited by Michael S. Niederman and Alimuddin Zumla Source Type: research

Transmission and prevention of acute viral respiratory tract infections in hospitals
Purpose of review Transmission of acute respiratory tract viral infections in healthcare environments is a major problem worldwide. We review recent literature of viruses imported to hospitals from the local community and from abroad, their modes of transmission and measures required to reduce and contain them. Recent findings Common causes of outbreaks include influenza viruses, respiratory syncytial virus, adenovirus, and coronaviruses. Major lethal outbreaks of viral respiratory infections in hospitals have been caused by coronaviruses imported from abroad by travelers. Summary Although viruses circulating in th...
Source: Current Opinion in Pulmonary Medicine - March 29, 2019 Category: Respiratory Medicine Tags: INFECTIOUS DISEASES: Edited by Michael S. Niederman and Alimuddin Zumla Source Type: research

Editorial: Toward improving the diagnosis, treatment and prevention of community acquired and nosocomial respiratory tract infections
No abstract available (Source: Current Opinion in Pulmonary Medicine)
Source: Current Opinion in Pulmonary Medicine - March 29, 2019 Category: Respiratory Medicine Tags: INFECTIOUS DISEASES: Edited by Michael S. Niederman and Alimuddin Zumla Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Pulmonary Medicine)
Source: Current Opinion in Pulmonary Medicine - March 29, 2019 Category: Respiratory Medicine Tags: EDITORIAL INTRODUCTIONS Source Type: research

Assessment and treatment of acute toxic inhalations
Purpose of review Acute toxic inhalation exposures affect thousands of individuals worldwide each year. The acute evaluation of these inhaled exposures is often fraught with difficulty in identifying a specific agent, may involve multiple compounds, and a wide variety of responses are seen depending on the physical properties of the specific toxicant, the length of time of inhalation, and the concentration of the exposure. Recognizing key aspects of the most common acute toxic inhalations is useful in developing a diagnosis and treatment strategy. Recent findings Use of sequential observations with flexible bronchosco...
Source: Current Opinion in Pulmonary Medicine - January 30, 2019 Category: Respiratory Medicine Tags: OBSTRUCTIVE, OCCUPATIONAL AND ENVIRONMENTAL DISEASES: Edited by Manish Joshi and Basil Varkey Source Type: research

Bronchoscopic device intervention in chronic obstructive pulmonary disease
Purpose of review Chronic obstructive pulmonary disease is a heterogeneous syndrome associated with varying degrees of parenchymal emphysema and airway inflammation resulting in decreased expiratory flow, lung hyperinflation, and symptoms leading to decreased exercise tolerance and quality of life. Impairment in lung function and quality of life persists following guideline-based medical therapy, thus surgical and minimally invasive bronchoscopic approaches were developed to address this unmet need. We offer a narrative review of the available technologies. Recent findings Although lung volume reduction surgery has be...
Source: Current Opinion in Pulmonary Medicine - January 30, 2019 Category: Respiratory Medicine Tags: OBSTRUCTIVE, OCCUPATIONAL AND ENVIRONMENTAL DISEASES: Edited by Manish Joshi and Basil Varkey Source Type: research

Noncystic fibrosis bronchiectasis management: opportunities and challenges
Purpose of review Noncystic fibrosis bronchiectasis is a challenging disease which carries a heavy healthcare burden and significant mortality and morbidity. This review highlights the challenges in the diagnosis of bronchiectasis and discusses the management strategies and research opportunities in this field. Recent findings The challenges in the management of bronchiectasis appear to be multifactorial, arising from both etiological heterogeneity and disease-specific management. Frequent inflammation and infections not only lead to progressive respiratory failure but also increase the risk of cardiovascular complica...
Source: Current Opinion in Pulmonary Medicine - January 30, 2019 Category: Respiratory Medicine Tags: OBSTRUCTIVE, OCCUPATIONAL AND ENVIRONMENTAL DISEASES: Edited by Manish Joshi and Basil Varkey Source Type: research