Changing landscape: psychological care in the era of cystic fibrosis transmembrane conductance regulator modulators
Purpose of review The current review provides an overview of key psychological issues and challenges for the cystic fibrosis (CF) transmembrane conductance regulator (CFTR) modulator era of care. It discusses research from diagnosis and beyond, to patient-team communication with a particular focus on medical trials, adherence and living with CFTR modulators. Recent findings The impact of the diagnosis on parents is immense and the complexity of treatment now and in the future, are a challenge for both parents and teams. Communicating digitally is starting to become daily practice for many in CF care, with coronavirus ...
Source: Current Opinion in Pulmonary Medicine - October 8, 2020 Category: Respiratory Medicine Tags: CYSTIC FIBROSIS: Edited by Peter J. Barry and Barry J. Plant Source Type: research

Sexual and reproductive health in cystic fibrosis
Purpose of review With improving life expectancy and quality of life, sexual and reproductive health (SRH) has become an increasingly important aspect of patient-centered cystic fibrosis care. This review aims to describe advances in cystic fibrosis-related SRH and highlight optimal practices. Recent findings Recent publications suggest that people with cystic fibrosis follow a similar trajectory of sexual development and activity as their noncystic fibrosis peers, although contraception use is lower. Although fertility is reduced in patients with cystic fibrosis, improved survival and assisted reproductive technologi...
Source: Current Opinion in Pulmonary Medicine - October 8, 2020 Category: Respiratory Medicine Tags: CYSTIC FIBROSIS: Edited by Peter J. Barry and Barry J. Plant Source Type: research

Treatment of pulmonary exacerbations in cystic fibrosis
Purpose of review This review will discuss the challenges of defining a pulmonary exacerbations in cystic fibrosis and the key pathogens, which contribute. It will discuss the treatment options currently available and the importance of preventing pulmonary exacerbations. Recent findings The basis for treatment of pulmonary exacerbations remains unchanged over the past 15 years and whilst there have been trials exploring alternative antibiotics, there has been little change. However, there are ongoing studies that are expected to establish a platform for identifying best practices. Chronic cystic fibrosis therapies hav...
Source: Current Opinion in Pulmonary Medicine - October 8, 2020 Category: Respiratory Medicine Tags: CYSTIC FIBROSIS: Edited by Peter J. Barry and Barry J. Plant Source Type: research

Monitoring early stage lung disease in cystic fibrosis
Purpose of review Early stage lung disease has long been synonymous with infancy and childhood. As diagnosis happens earlier and conventional management improves, we are seeing larger proportions of people with cystic fibrosis (CF) in adolescence and even adulthood with well preserved lung health. The availability of highly effective cystic fibrosis transmembrane conductance regulator modulator drugs for a large proportion of the CF population will impact even further. Transitioning into adult care with ‘normal’ lung function will become more common. However, it is crucial that we are not blasé about t...
Source: Current Opinion in Pulmonary Medicine - October 8, 2020 Category: Respiratory Medicine Tags: CYSTIC FIBROSIS: Edited by Peter J. Barry and Barry J. Plant Source Type: research

Editorial: The changing landscape of cystic fibrosis: new therapies, challenges and a global pandemic
No abstract available (Source: Current Opinion in Pulmonary Medicine)
Source: Current Opinion in Pulmonary Medicine - October 8, 2020 Category: Respiratory Medicine Tags: CYSTIC FIBROSIS: Edited by Peter J. Barry and Barry J. Plant Source Type: research

Obstructive sleep apnea and cancer: a complex relationship
Purpose of review Obstructive sleep apnea (OSA) has been recognized as a risk factor for cancer mainly through hypoxia, based on studies that did not distinguish among cancer types. The purpose of this review is to discuss the most recent data on epidemiology and pathophysiology of the OSA–cancer association. Recent findings According to epidemiological studies, OSA may have different influences on each type of cancer, either increasing or decreasing its incidence and aggressiveness. Time spent with oxygen saturation below 90% appears the polysomnographic variable most strongly associated with unfavorable effect...
Source: Current Opinion in Pulmonary Medicine - October 8, 2020 Category: Respiratory Medicine Tags: SLEEP AND RESPIRATORY NEUROBIOLOGY: Edited by Lee Brown and Winfried Johannes Randerath Source Type: research

Alternative algorithms and devices in sleep apnoea diagnosis: what we know and what we expect
Purpose of review Diagnosis of sleep apnoea was performed in sleep laboratories with polysomnography. This requires a room with supervision and presence of technologists and trained sleep experts. Today, clinical guidelines in most countries recommend home sleep apnoea testing with simple systems using six signals only. If criteria for signal quality, recording conditions, and patient selection are considered, then this is a reliable test with high accuracy. Recent findings Recently diagnostic tools for sleep apnoea diagnosis become even more simple: smartwatches and wearables with smart apps claim to diagnose sleep a...
Source: Current Opinion in Pulmonary Medicine - October 8, 2020 Category: Respiratory Medicine Tags: SLEEP AND RESPIRATORY NEUROBIOLOGY: Edited by Lee Brown and Winfried Johannes Randerath Source Type: research

Does gender matter: sex-specific aspects of symptoms, outcome, and therapy of obstructive sleep apnea
Purpose of review Obstructive sleep apnea (OSA) has historically been considered as a male disease. As a result, female individuals with OSA were often under-diagnosed and under-treated compared with male individuals. However, recent data suggest that several OSA-associated adverse cardiovascular outcomes are more pronounced in women. Recent findings This review provides a summary of the most relevant recent evidence with regard to sex-specific OSA characteristics, including atypical symptoms, greater quality of life impairment and several more pronounced adverse outcomes in female individuals compared with male indiv...
Source: Current Opinion in Pulmonary Medicine - October 8, 2020 Category: Respiratory Medicine Tags: SLEEP AND RESPIRATORY NEUROBIOLOGY: Edited by Lee Brown and Winfried Johannes Randerath Source Type: research

Opioids and sleep
Purpose of review Summarize the effects of opioids on sleep including sleep architecture, sleep disordered breathing (SDB) and restless legs syndrome. Recent findings Opioids are associated with the development of central sleep apnea (CSA) and ataxic breathing. Recent reports suggest that adaptive servo-ventilation may be an effective treatment for CSA associated with opioids. Summary Opioids have multiple effects on sleep, sleep architecture and SDB. Although originally described with methadone use, most commonly used opioids have also been shown to affect sleep. In patients on chronic methadone, sleep architectur...
Source: Current Opinion in Pulmonary Medicine - October 8, 2020 Category: Respiratory Medicine Tags: SLEEP AND RESPIRATORY NEUROBIOLOGY: Edited by Lee Brown and Winfried Johannes Randerath Source Type: research

New pharmacologic agents for insomnia and hypersomnia
Purpose of review Insomnia and hypersomnia are conditions with multifactorial causes that can be difficult to treat. There have been recent developments and changes in the treatment of both conditions, including the addition of some agents that have a novel mechanism of action. This review summarizes recent changes and highlights pertinent updates. Recent findings Benzodiazepine receptor agonists received a warning in 2019 regarding the possibility of complex sleep behaviors, such as sleepwalking. Zolpidem has been marketed in new dosage forms that include sublingual tablets and oral spray formulations. Orexin recepto...
Source: Current Opinion in Pulmonary Medicine - October 8, 2020 Category: Respiratory Medicine Tags: SLEEP AND RESPIRATORY NEUROBIOLOGY: Edited by Lee Brown and Winfried Johannes Randerath Source Type: research

Drug-induced sleep endoscopy: techniques, interpretation and implications
Purpose of review The purpose of this article is to highlight recent advances in the burgeoning field of drug-induced sleep endoscopy (DISE). Recent findings One of the first studies to investigate the correlation of DISE findings and natural sleep endoscopy found good agreement in clinically significant obstruction. Previous studies have shown good agreement of DISE findings with the use of different sedative agents implying that the choice of sedative may not be crucial. However, recent studies show variable patterns of collapse, especially at the tongue base, with the use of different sedative agents. A universally...
Source: Current Opinion in Pulmonary Medicine - October 8, 2020 Category: Respiratory Medicine Tags: SLEEP AND RESPIRATORY NEUROBIOLOGY: Edited by Lee Brown and Winfried Johannes Randerath Source Type: research

Respiratory and sleep-related complications of multiple system atrophy
Purpose of review The purpose of this article is to provide a contemporary review of sleep issues affecting patients with multiple system atrophy (MSA). Recent findings Prodromal symptoms of MSA may occur years prior to diagnosis, including autonomic dysfunction such as orthostatic hypotension, urogenital dysfunction, rapid eye movement (REM) sleep behavior disorder (RBD), and stridor. Patients may also develop sleep-related respiratory disorders such as obstructive sleep apnea (OSA), central sleep apnea (CSA), and stridor. The development of stridor is associated with a shortened lifespan and sudden death, which may ...
Source: Current Opinion in Pulmonary Medicine - October 8, 2020 Category: Respiratory Medicine Tags: SLEEP AND RESPIRATORY NEUROBIOLOGY: Edited by Lee Brown and Winfried Johannes Randerath Source Type: research

Endotypes and phenotypes in obstructive sleep apnea
Purpose of review The purpose of this review is to describe the variability of obstructive sleep apnea (OSA), both from a standpoint of underlying mechanisms and in terms of clinical manifestations. Recent findings Recent data suggest that not all patients with sleep apnea get their disease for the same reason. As such, no one variable is effective at defining which patients do or do not have sleep apnea. Identifying the mechanism(s) underlying OSA for an individual is helpful as it can help to determine whether personalized therapy could be developed based on an individual's characteristics. In addition, these underl...
Source: Current Opinion in Pulmonary Medicine - October 8, 2020 Category: Respiratory Medicine Tags: SLEEP AND RESPIRATORY NEUROBIOLOGY: Edited by Lee Brown and Winfried Johannes Randerath Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Pulmonary Medicine)
Source: Current Opinion in Pulmonary Medicine - October 8, 2020 Category: Respiratory Medicine Tags: EDITORIAL INTRODUCTIONS Source Type: research

Looking into the future of sarcoidosis: what is next for treatment?
Purpose of review Sarcoidosis is a complex granulomatous disease of unknown cause. Corticosteroids and immune suppressants are often given long term in chronic disease, which may result in substantial toxicity. Validated strategies for selecting patients at risk for disease progression, who might benefit from early and targeted treatment, are lacking. Consequently, the unmet need for new treatment options in sarcoidosis is high. In this review, we critically discuss potential therapeutic targets and ongoing clinical trials in sarcoidosis. Recent findings Despite the heterogeneous clinical manifestations and the lack o...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: SARCOIDOSIS: Edited by Daniel A. Culver and Hilario Nunes Source Type: research

Current treatment of sarcoidosis
Purpose of review Sarcoidosis is a granulomatous systemic disease of unknown cause where the lung is the most frequently affected organ. Therapeutic management of the disease is challenging as clinical presentation and prognosis are very heterogeneous. In the present review, we will summarize the main advances in sarcoidosis therapy. Recent findings Current sarcoidosis therapies are categorized in three lines: glucocorticoids (first line), immunosuppressants (second line), and biologics (third line). Recent glucocorticoid studies have reported that efficacy could be similar with high and low doses, but with an increas...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: SARCOIDOSIS: Edited by Daniel A. Culver and Hilario Nunes Source Type: research

An update on sarcoidosis-associated pulmonary hypertension
Purpose of review Pulmonary hypertension in sarcoidosis is a well known entity. Sarcoidosis-associated pulmonary hypertension (SAPH) incurs substantial morbidity and mortality. This review examines recent literatures published on epidemiology, prognosis and therapeutic management in SAPH. Recent findings Several registries have been published between 2017 and 2020. The consensus conclusion – SAPH is a harbinger for poor prognosis. Several factors were noted for predicting adverse outcome in SAPH like reduced 6-min walk distance and diffusing capacity for carbon monoxide. Given its adverse outcome, experts have n...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: SARCOIDOSIS: Edited by Daniel A. Culver and Hilario Nunes Source Type: research

Advanced pulmonary sarcoidosis
Purpose of review Mortality in patients with sarcoidosis has primarily been attributed to advanced pulmonary sarcoidosis. This review aims to provide an update on recent clinical studies that help to better phenotype these patients, discuss new treatment options, and suggest areas where additional research is needed. Recent findings Diagnosis and management of advanced pulmonary sarcoidosis has changed as new technologies and treatment options have emerged. Clinical phenotypes of advanced disease have evolved to show overlap in presentation with other interstitial lung diseases. Assessment involves more advanced imagi...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: SARCOIDOSIS: Edited by Daniel A. Culver and Hilario Nunes Source Type: research

Socioeconomic determinants and disparities in sarcoidosis
Purpose of review The aim of this article is to describe the known health disparities that exist among patients with sarcoidosis by socioeconomic status, race, and gender, review potential contributors to health disparities in sarcoidosis, investigate the intersectionality among socioeconomic status, race, and gender in sarcoidosis, and outline a research agenda to address these disparities. Recent findings Recent studies have reported the significant financial strain a diagnosis of sarcoidosis has on individuals and the disproportionate affect the strain has on low socioeconomic status individuals, Blacks, and female...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: SARCOIDOSIS: Edited by Daniel A. Culver and Hilario Nunes Source Type: research

Molecular profiling in sarcoidosis
Purpose of review Sarcoidosis is a systemic disease characterized by granulomatous inflammation of unknown cause. There is extensive heterogeneity between patients with respect to the number and types of organs involved, disease course, and response to therapy. Recent research in the field has leveraged ‘omics’ techniques such as transcriptomics to identify important ‘molecular profiles’ in the disease. These tools may help in identifying clinically useful biomarkers and targets for therapy. Recent findings Several studies have used gene expression profiling of predesignated lists or the entire...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: SARCOIDOSIS: Edited by Daniel A. Culver and Hilario Nunes Source Type: research

Experimental models of sarcoidosis: where are we now?
Purpose of review Sarcoidosis remains a mysterious disease that presents many challenges both in pathogenetic understanding and in the management of patients. This review presents experimental models for sarcoidosis developed since 2016 and discusses their strengths and weaknesses and how they have contributed to the understanding and therapeutic approaches in this disease. In addition, future directions are proposed to overcome the limitations of current models. Recent findings New cellular models using infectious antigen as trigger, and transgenic models in mice have recently been developed to study signaling pathwa...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: SARCOIDOSIS: Edited by Daniel A. Culver and Hilario Nunes Source Type: research

Recent advances in sarcoidosis genomics: epigenetics, gene expression, and gene by environment (G × E) interaction studies
Purpose of review We aim to review the most recent findings in genomics of sarcoidosis and highlight the gaps in the field. Recent findings Original explorations of sarcoidosis subphenotypes, including cases associated with the World Trade Center and ocular sarcoidosis, have identified novel risk loci. Innovative gene--environment interaction studies utilizing modern analytical techniques have discovered risk loci associated with smoking and insecticide exposure. The application of whole-exome sequencing has identified genetic variants associated with persistent sarcoidosis and rare functional variations. A single epi...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: SARCOIDOSIS: Edited by Daniel A. Culver and Hilario Nunes Source Type: research

Immunology of sarcoidosis: old companions, new relationships
Purpose of review The immune determinants of granuloma formation and disease progression in sarcoidosis have not been completely disclosed, and the role of both innate and the adaptive immunity is still under investigation. Recent findings M2 macrophage polarization, previously thought to be a specific feature of a progressing and fibrosing disease, has been related to the initial steps of granuloma formation both in animal and in-vitro models. The dysregulation of specific metabolic pathways and autophagy has been associated with disease activity and progression. T cells have been reported to be strongly influenced b...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: SARCOIDOSIS: Edited by Daniel A. Culver and Hilario Nunes Source Type: research

Sarcoidosis epidemiology: recent estimates of incidence, prevalence and risk factors
Purpose of review The aim of this review is to describe the latest studies on sarcoidosis incidence, prevalence and risk factors with a special focus on reports in the last 2 years. The potential biases affecting these studies are discussed. Recent findings The prevalence and incidence of sarcoidosis vary greatly depending on region of the world. Variations in data sources and settings can affect estimates of the burden of sarcoidosis, sometimes making them difficult to compare across countries. It is not well understood how the distribution of sarcoidosis phenotypes differs across populations. Age, sex and race are t...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: SARCOIDOSIS: Edited by Daniel A. Culver and Hilario Nunes Source Type: research

The future is now: a generation of sarcoidologists emerges
No abstract available (Source: Current Opinion in Pulmonary Medicine)
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: SARCOIDOSIS: Edited by Daniel A. Culver and Hilario Nunes Source Type: research

Advances in lung transplantation for interstitial lung diseases
Purpose of review Lung transplantation (LTx) is increasingly used as ultimate treatment modality in end-stage interstitial lung diseases (ILDs). This review aims to give an overview of the latest evolutions in this field. Recent findings In the last two years, important new findings regarding LTx outcomes in specific ILD entities have been reported. More data are available on optimization of pre-LTx management of ILD patients especially with regard to pretransplant antifibrotic treatment. Summary LTx is the only treatment option with curative intent for ILDs and is increasingly used for this indication. Several stu...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: INTERSTITIAL LUNG DISEASE: Edited by Bruno Crestani and Martin R.J. Kolb Source Type: research

Insights into pathogenesis and clinical implications in myositis-associated interstitial lung diseases
Purpose of review Interstitial lung diseases (ILDs) have been reported to be associated with myositis (including polymyositis and dermatomyositis). These myositis-associated ILDs carry significant morbidity and mortality. This review summarizes recent findings on myositis-associated ILD with a focus on pathogenesis and emerging treatment. Recent findings Recent advances in genetics have revealed 22 myositis-associated genome-wide loci, which were significantly enriched in regulatory regions in immune cells. An analysis of such disease-associated loci elucidated potential drug targets (e.g., TYK2 targeted by tofacitini...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: INTERSTITIAL LUNG DISEASE: Edited by Bruno Crestani and Martin R.J. Kolb Source Type: research

New therapeutic strategies in lung vasculitis
Purpose of review To summarize the latest publications and provide a practical overview of treatment strategies for lung vasculitis associated with antineutrophil cytoplasmic antibodies (ANCAs). Recent findings In patients with severe ANCA-associated vasculitis, plasma exchange, as adjunctive therapy to standard treatment, is not associated with improved survival or reduced risk of end-stage kidney disease. A regimen with reduced dose of glucocorticoids is equally effective to induce remission as a standard regimen. In patients without organ or life-threatening disease, mycophenolate mofetil can be used in combination...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: INTERSTITIAL LUNG DISEASE: Edited by Bruno Crestani and Martin R.J. Kolb Source Type: research

Systemic sclerosis-associated interstitial lung disease
Purpose of review In this review, the authors discuss systemic sclerosis-associated interstitial lung disease (SSc-ILD) with a focus on recent developments in diagnosis, surveillance, and management. Recent findings With advances in the management of SSc, the importance of ILD has been increasingly recognized and is the leading cause of mortality. Early detection is essential, and a combination of lung function testing and chest imaging are key tools in diagnosis and surveillance. The foundation of treatment is immunomodulation with recent studies identifying several potential new agents. The use of therapies targetin...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: INTERSTITIAL LUNG DISEASE: Edited by Bruno Crestani and Martin R.J. Kolb Source Type: research

Recent advances in rheumatoid arthritis-associated interstitial lung disease
Purpose of review To provide an overview of recent studies that could be helpful in a better understanding of rheumatoid arthritis-associated interstitial lung disease (RA-ILD) and to facilitate the clinical management of this severe complication of RA. Recent findings The advances in deciphering the genetic architecture of RA-ILD support the hypothesis of RA-ILD as a complex disease with a complex phenotype encompassing at least the usual interstitial pneumonia (UIP) high-resolution CT pattern and non-UIP. Genetics studies have provided evidence for a shared genetic background in idiopathic pulmonary fibrosis (IPF) a...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: INTERSTITIAL LUNG DISEASE: Edited by Bruno Crestani and Martin R.J. Kolb Source Type: research

Pulmonary rehabilitation in interstitial lung diseases
Purpose of review This review will provide an overview of the components and current evidence to support pulmonary rehabilitation in patients with interstitial lung diseases (ILD), focusing on the latest findings in enhancing quality of life and functional capacity using exercise training and education. Recent findings Recent literature demonstrates a longer duration of pulmonary rehabilitation results in sustained improvements in functional capacity and quality of life in patients with ILD. Educational components tailored to ILD provide added value to supervised exercise training. Enhancing exercise training with hyp...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: INTERSTITIAL LUNG DISEASE: Edited by Bruno Crestani and Martin R.J. Kolb Source Type: research

Oxygen for interstitial lung diseases
Purpose of review Supplemental oxygen therapy is prescribed for management of hypoxaemia in patients with interstitial lung disease (ILD). This review summarizes current evidence and implications of the use of supplemental oxygen therapy at home and during exercise training in ILD. Recent findings Despite the significance of hypoxaemia in patients with ILD, there is a lack of high-quality evidence to guide the use of oxygen therapy in this population. Recent studies suggest that ambulatory oxygen may improve symptoms and health-related quality of life in patients with ILD. Long-term oxygen therapy for resting hypoxaem...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: INTERSTITIAL LUNG DISEASE: Edited by Bruno Crestani and Martin R.J. Kolb Source Type: research

Burden of idiopathic pulmonary fibrosis on patients’ emotional well being and quality of life: a literature review
Purpose of review To present an overview of the impact of idiopathic pulmonary fibrosis (IPF) on patients’ emotional well being and quality of life (QoL). Recent findings IPF is an interstitial lung disease which causes irreversible, progressive lung scarring in a pathological pattern of usual interstitial pneumonia. The incidence of IPF is increasing at a global level, subjecting an increasing number of people to its high morbidity and risk of mortality. Diagnosis is based on a multidisciplinary team approach and the exclusion of other interstitial lung diseases. Two novel antifibrotic treatments, pirfenidone a...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: INTERSTITIAL LUNG DISEASE: Edited by Bruno Crestani and Martin R.J. Kolb Source Type: research

Frailty in patients with interstitial lung disease
Purpose of review The incidence of age-related diseases such as interstitial lung disease (ILD) is rising, and the importance of multimorbidity and accumulation of health deficits in patients with chronic lung diseases is increasingly recognized. There are multiple relationships between aging and ILD on a demographic and a biological level. Frailty conceptualizes the decline of a patient's physiological reserves and complements the chronological and biological aspects of aging. Recent findings Frailty affects more than 50% of patients with ILD, with respiratory impairment, accelerated biological aging, comorbidities, ...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: INTERSTITIAL LUNG DISEASE: Edited by Bruno Crestani and Martin R.J. Kolb Source Type: research

Obstructive sleep apnea in pulmonary fibrosis
Purpose of review In previous years, there was limited research related to the role of sleep in interstitial lung diseases (ILDs). Physicians treating ILD patients tended to focus mainly on the daily disabling symptoms overlooking the possible significant role of coexisting sleep disorders, such as obstructive sleep apnea (OSA). However, recently, there has been a growing interest in OSA in ILDs, as well as OSA effect on sleep, life quality and outcome in these patients with emphasis on idiopathic pulmonary fibrosis (IPF). Recent findings OSA has been recognized as an important, high-prevalence comorbidity for the dia...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: INTERSTITIAL LUNG DISEASE: Edited by Bruno Crestani and Martin R.J. Kolb Source Type: research

Progressive fibrosing interstitial lung disease: treatable traits and therapeutic strategies
Purpose of review In this review, the authors describe therapeutic strategies for a disease group called progressive fibrosing interstitial lung disease (PF-ILD) and highlight the importance of the definition of progression, prognosis, and treatment response. Recent findings Although it is a relatively new concept, the term PF-ILD has been increasingly applied in clinical research and practice. Three domains commonly used to detect the disease progression include clinical symptoms, rate of forced vital capacity (FVC) decline and the extent of fibrosis on imaging. Although details of the pathogenesis of PF-ILD are stil...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: INTERSTITIAL LUNG DISEASE: Edited by Bruno Crestani and Martin R.J. Kolb Source Type: research

Pathogenesis of fibrosis in interstitial lung disease
Purpose of review Pulmonary fibrosis is a chronic and progressive lung disease involving unclear pathological mechanisms. The present review presents and discusses the major and recent advances in our knowledge of the pathogenesis of lung fibrosis. Recent findings The past months have deepened our understanding on the cellular actors of fibrosis with a better characterization of the abnormal lung epithelial cells observed during lung fibrosis. Better insight has been gained into fibroblast biology and the role of immune cells during fibrosis. Mechanistically, senescence appears as a key driver of the fibrotic process....
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: INTERSTITIAL LUNG DISEASE: Edited by Bruno Crestani and Martin R.J. Kolb Source Type: research

Pulmonary arterial hypertension: closing the gap in congenital heart disease
Purpose of review Pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD) is a common association adversely affecting quality of life and survival in these patients. We provide herewith recent advances in the understanding and management of PAH-CHD. Recent findings Significant progress has been made in disease-targeting therapy with pulmonary vasodilators for the treatment of Eisenmenger syndrome, the most severe form of PAH-CHD. Important gaps, however, still exist in the assessment and management of patients with PAH-CHD with systemic to pulmonary shunts. The choice of therapy, either inte...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: DISORDERS OF THE PULMONARY CIRCULATION: Edited by Steven D. Nathan and Christopher S. King Source Type: research

Critical care of patients with pulmonary arterial hypertension
This article will summarize the available literature and expert guidance on the topic. Patients with pulmonary arterial hypertension may require ICU care as a direct consequence of decompensated right heart failure. Alternatively, patients with pulmonary arterial hypertension may be affected by the myriad of maladies encountered every day in the ICU including acute respiratory failure, septic shock, and gastrointestinal bleeding. The treatment plan should focus on identifying and treating the cause for decompensation. In addition, optimization of right ventricular preload, reduction of right ventricular afterload, correcti...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: DISORDERS OF THE PULMONARY CIRCULATION: Edited by Steven D. Nathan and Christopher S. King Source Type: research

Evolving spectrum of treatment for CTEPH
Purpose of review The present review provides an update on treatment of chronic thromboembolic pulmonary hypertension (CTEPH), a rare form of pulmonary hypertension characterized by precapillary pulmonary hemodynamic parameters with chronic thrombotic occlusion of the pulmonary vasculature. Recent findings Pulmonary thromboendarectomy (PTE) remains the recommended treatment for patients with surgically accessible disease. Recent data suggest that patients preoperatively bridged with medical therapy may have improved outcomes but further research is needed. Riociguat improves hemodynamics, right ventricular function, q...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: DISORDERS OF THE PULMONARY CIRCULATION: Edited by Steven D. Nathan and Christopher S. King Source Type: research

Advanced therapies for pulmonary embolism
Purpose of review Treatment options for managing patients with acute pulmonary embolism are rapidly evolving. In this review, we discuss the supporting evidence and implementation strategies for these advanced therapeutic modalities. Recent findings We review the recent data supporting systemic and catheter directed thrombolytic therapies, mechanical embolectomy, use of extracorporeal membrane oxygen support, and pulmonary embolism response teams in managing patients with acute pulmonary embolism. We discuss the major professional society recommendations regarding their implementation. Summary A review of advanced ...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: DISORDERS OF THE PULMONARY CIRCULATION: Edited by Steven D. Nathan and Christopher S. King Source Type: research

Clinical trials in group 3 pulmonary hypertension
Purpose of review Despite worse outcomes associated with the development of pulmonary hypertension in chronic lung disease, there are no approved treatments for this population. The present review summarizes the recent clinical trials in World Symposium on Pulmonary Hypertension (WSPH) Group 3 pulmonary hypertension, with a particular focus on the study of pulmonary arterial hypertension (PAH)-targeted therapy. Recent findings Multiple recent randomized controlled trials have studied a host of PAH-specific medications in the treatment of WSPH Group 3 pulmonary hypertension, including endothelin receptor antagonists, p...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: DISORDERS OF THE PULMONARY CIRCULATION: Edited by Steven D. Nathan and Christopher S. King Source Type: research

How low should we go? Potential benefits and ramifications of the pulmonary hypertension hemodynamic definitions proposed by the 6th World Symposium
Purpose of review The 6th World Symposium on Pulmonary Hypertension (WSPH) proposed lowering the mean pulmonary artery pressure (mPAP) threshold that defines pulmonary hypertension from ≥ 25 to> 20 mmHg. The historical context and evolution of the pulmonary hypertension definition and the data used to rationalize recent changes are reviewed here. Recent findings There are accumulating data on the clinical significance of mildly elevated mPAPs (21–24 mmHg). Studies have demonstrated lower exercise capacity and an increased risk of progression to overt pulmonary hypertension (mPAP ≥ 25 mmHg) in ...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: DISORDERS OF THE PULMONARY CIRCULATION: Edited by Steven D. Nathan and Christopher S. King Source Type: research

Pulmonary hypertension in majority countries: opportunities amidst challenges
This article provides a review of pulmonary hypertension in majority countries, focusing in detail on the most common causes in these regions, and highlights contextual challenges faced. Recent findings Epidemiological data confirms a complex and overlapping array of causes, with pulmonary hypertension because of conditions such as rheumatic heart disease, HIV, schistosomiasis, chronic lung disease and sickle cell disease. Delayed pulmonary hypertension diagnosis remains a concern and is ascribed to a lack of resources and lack of pulmonary hypertension awareness by health professionals. Pulmonary hypertension diagnosis...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: DISORDERS OF THE PULMONARY CIRCULATION: Edited by Steven D. Nathan and Christopher S. King Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Pulmonary Medicine)
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: EDITORIAL INTRODUCTIONS Source Type: research

Role of antioxidants in the treatment of gastroesophageal reflux disease-associated idiopathic pulmonary fibrosis
Purpose of review Idiopathic pulmonary fibrosis (IPF) is a terminal lung disease of largely unknown cause. Gastroesophageal reflux disease (GERD) was recently discovered to be a trigger for the development of IPF. The current pharmaceutical approach to IPF falls short and there is a pressing need for improved therapeutic options. The present review describes the currently available knowledge regarding the role of oxidative stress and inflammation in the pathophysiology of IPF and GERD and determines the potential use of antioxidants as a treatment option for GERD-associated IPF. Recent findings IPF and GERD share a si...
Source: Current Opinion in Pulmonary Medicine - June 5, 2020 Category: Respiratory Medicine Tags: NUTRITION AND DRUGS: Edited by Aalt Bast Source Type: research

Interaction of diet and drugs in lung disease
Purpose of review The current review aims to seek attention for the interaction between drugs and nutrition. Traditionally, drugs and nutrition are regarded as separate categories. Nutrition is to maintain health and drugs are for curing disease. Dieticians deal with food and the medical doctor prescribes drugs. During the last decade, both categories are getting closer. Recent findings Some drugs used in pulmonology lead to decrease in nutrients. Other drugs negatively affect taste. This is remarkable because the diseases for which these drugs are intended, benefit from nutrition. Gradually examples emerge that sugge...
Source: Current Opinion in Pulmonary Medicine - June 5, 2020 Category: Respiratory Medicine Tags: NUTRITION AND DRUGS: Edited by Aalt Bast Source Type: research

What's new in endobronchial ultrasound for mediastinal staging?
Purpose of review The essential role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in lung cancer diagnosis and staging is now well established. With a growing body of evidence seen over the last decade, the objective of this article was to review the newest findings, provide evidence-based guidance to clinicians and identify areas for future research related to EBUS-TBNA and staging in lung cancer. Recent findings Recent literature regarding EBUS-TBNA for lung cancer staging was reviewed, with a focus on evidence published subsequent to the 2016 guideline on technical aspects of EBUS...
Source: Current Opinion in Pulmonary Medicine - June 5, 2020 Category: Respiratory Medicine Tags: NEOPLASMS OF THE LUNG: Edited by Alan M. Fein and David E. Ost Source Type: research

Management of malignant pleural effusions
This article provides a summary of the most up-to-date evidence in this area. Recent findings Recent publications have demonstrated comparable pleurodesis outcomes of talc slurry to talc poudrage and explore strategies to combine the advantages of indwelling pleural catheters (IPCs) with a chemical pleurodesis. A daily IPC drainage regime improves the chances of pleurodesis success and early IPC removal in patients without significant trapped lung. Summary MPE is a diverse condition, with no one strategy representing the ‘best’ approach for all. Management decisions should be made in conjunction with the ...
Source: Current Opinion in Pulmonary Medicine - June 5, 2020 Category: Respiratory Medicine Tags: NEOPLASMS OF THE LUNG: Edited by Alan M. Fein and David E. Ost Source Type: research

Pneumonitis associated with immune checkpoint inhibitors among patients with non-small cell lung cancer
Purpose of review Patients with lung cancer are particularly vulnerable to lung injury associated with immune checkpoint inhibition and often present with more frequent and more severe manifestations of lung disease compared to patients with other tumor types. The present review explores the reasons for increased susceptibility to immune checkpoint-related lung injury among this group of patients and focuses on the current knowledge of the clinical and radiologic manifestations of lung injury associated with immune checkpoint blockade and current treatment strategies. Recent findings Recent investigations have shown t...
Source: Current Opinion in Pulmonary Medicine - June 5, 2020 Category: Respiratory Medicine Tags: NEOPLASMS OF THE LUNG: Edited by Alan M. Fein and David E. Ost Source Type: research