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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 specific ...
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 patient,...
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