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A contemporary review of radiation pneumonitis
Purpose of review The current article reviews recent literature and summarizes the current understanding, diagnosis, risk, predictors, and management of radiation pneumonitis. Recent findings We discuss the different parameters that contribute to radiation toxicity, the potential biomarkers that predict the risk, and mitigators of radiation pneumonitis. Summary Radiotherapy aims to provide care and a better quality of life in cancer patients however with complications. Radiation pneumonitis is important to recognize to appropriately plan and care for this population. (Source: Current Opinion in Pulmonary Medicine)
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

Approach to stage IV non-small-cell lung cancer: how to select among first-line therapy options?
Purpose of review There are several first-line systemic therapy options for patients with newly diagnosed stage IV non-small-cell lung cancer. Targeted therapy with tyrosine kinase inhibitors provide a good first option for some. Unfortunately, most patients do not have an alteration for which there is an available tyrosine kinase inhibitor. For these patients there are immunotherapy and chemoimmunotherapy options; however, there is debate about how to choose amongst these treatments for a given individual. This review attempts to simplify this decision-making process. Recent findings The data on first-line immunother...
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

Editorial introductions
No abstract available (Source: Current Opinion in Pulmonary Medicine)
Source: Current Opinion in Pulmonary Medicine - June 5, 2020 Category: Respiratory Medicine Tags: EDITORIAL INTRODUCTIONS Source Type: research

Human global and population-specific genetic susceptibility to Mycobacterium tuberculosis infection and disease
Purpose of review Multiple lines of evidence support a role of the host genetic component in Mycobacterium tuberculosis infection and disease progression. However, genomic studies of tuberculosis susceptibility have been disappointing compared with that of other complex disorders. Recently the field has explored alternative strategies to facilitate locus discovery. Results emanating from these efforts during the last 18 months are addressed in this review. Recent findings There has been a renewed focus on the refinement of phenotypic definitions of infection and disease as well as on age-related, sex-specific and popu...
Source: Current Opinion in Pulmonary Medicine - April 2, 2020 Category: Respiratory Medicine Tags: GENETICS: Edited by Coline H.M. van Moorsel Source Type: research

ABCA3 mutations in adult pulmonary fibrosis patients: a case series and review of literature
Purpose of review The current review aims to recognize the variability in clinical presentation of adult patients with bi-allelic ABCA3 mutations, create more depth in ABCA3 mutations reported and highlight the influence of environmental factors on disease course. Recent findings Mutations in ABCA3 are predominantly linked to neonatal and pediatric interstitial lung disease (ILD) with a minority surviving beyond puberty. Here, we present three patients with ABCA3 mutations who present with disease at the age of 19, 61 and 77. Moreover, we identified c.4451G>C (p.R1484P), c.1675G>A (p.G559R) and c.4745C>G (p.T1582S) as...
Source: Current Opinion in Pulmonary Medicine - April 2, 2020 Category: Respiratory Medicine Tags: GENETICS: Edited by Coline H.M. van Moorsel Source Type: research

MicroRNAs: future biomarkers and targets of therapy in asthma?
Purpose of review MicroRNAs (miRNAs) are small noncoding RNA molecules that are considered one of the fundamental regulatory mechanisms of gene expression. They are involved in many biologic processes, such as signal transduction, cell proliferation and differentiation, apoptosis and stress responses. The purpose of this review is to present recent knowledge about the role of miRNAs in asthma and outline possible applications of miRNAs. Recent findings A core set of miRNAs involved in asthma includes downregulated let-7 family, miR-193b, miR-375 as well as upregulated miR-21, miR-223, miR-146a, miR-142-5p, miR-142-3p,...
Source: Current Opinion in Pulmonary Medicine - April 2, 2020 Category: Respiratory Medicine Tags: GENETICS: Edited by Coline H.M. van Moorsel Source Type: research

TBX4 variants and pulmonary diseases: getting out of the ‘Box’
Purpose of review In 2013, the association between T-Box factor 4 (TBX4) variants and pulmonary arterial hypertension (PAH) has first been described. Now – in 2020 – growing evidence is emerging indicating that TBX4 variants associate with a wide spectrum of lung disorders. Recent findings TBX4 variants are enriched in both children and adults with PAH. The clinical phenotype associated with a TBX4 variant seems to be milder than that in other PAH-associated gene mutations. Further, TBX4 variants have increasingly been associated with a variety of clinical and histopathological phenotypes, including lethal develop...
Source: Current Opinion in Pulmonary Medicine - April 2, 2020 Category: Respiratory Medicine Tags: GENETICS: Edited by Coline H.M. van Moorsel Source Type: research

Pharmacogenetics of antitumor necrosis factor therapy in severe sarcoidosis
Purpose of review Antitumor necrosis factor (TNF) treatment is an effective third-line treatment option in severe sarcoidosis. But not all patients respond to treatment. Pharmacogenetics studies the influence of genetic variations on treatment response. Recent findings In sarcoidosis, only one study reported on a relationship between genetic variation in TNF and response to anti-TNF therapy. In immune-mediated inflammatory diseases (IMIDs) other than sarcoidosis, several genetic variants were associated with response to anti-TNF therapy. Genes related to TNF, the target of this group of drugs, and the pathway by which...
Source: Current Opinion in Pulmonary Medicine - April 2, 2020 Category: Respiratory Medicine Tags: GENETICS: Edited by Coline H.M. van Moorsel Source Type: research

Beyond antibiotics for pulmonary nontuberculous mycobacterial disease
Purpose of review Pulmonary nontuberculous mycobacterial disease (NTM) remains a significant clinical challenge with suboptimal therapy. This review focuses on recent understandings around the pathogenesis of NTM disease and nonantibiotic therapeutic approaches that are being pursued. Recent findings The absence of animal models that truly replicate human disease remains a major problem for NTM research with most findings coming from tuberculosis or tuberculosis-like studies. Recent research reiterates the known key roles of interferon gamma (IFNγ), tumor necrosis factor, interleukin-12 and granulocyte-macrophage col...
Source: Current Opinion in Pulmonary Medicine - April 2, 2020 Category: Respiratory Medicine Tags: INFECTIOUS DISEASES: Edited by Michael S. Niederman and Alimuddin Zumla Source Type: research

Strategies for prediction of drug-resistant pathogens and empiric antibiotic selection in community-acquired pneumonia
Purpose of review Although most patients with community-acquired pneumonia (CAP) are appropriately treated with narrow-spectrum antibiotics, predicting which patients require coverage of drug-resistant pathogens (DRP) remains a challenge. The 2019 American Thoracic Society/Infectious Diseases Society of America CAP guidelines endorse using locally validated prediction models for DRP. Here we review risk factors for DRP and provide a summary of available risk prediction models. Recent findings Both inadequate initial empiric spectrum as well as unnecessary broad-spectrum antibiotic use are associated with poor outcomes...
Source: Current Opinion in Pulmonary Medicine - April 2, 2020 Category: Respiratory Medicine Tags: INFECTIOUS DISEASES: Edited by Michael S. Niederman and Alimuddin Zumla Source Type: research

Advances in molecular diagnostic tests for pneumonia
Purpose of review Pneumonia is the main global cause of sepsis, and has been associated with high morbidity and high short and long-term mortality rates. As it may be caused by a wide spectrum of microorganisms, microbial diagnosis is challenging and the choice of adequate therapy remains an important problem. This review focuses on recently published studies of microbiological diagnostic tests and clinical assessments for pneumonia, including community-acquired pneumonia, hospital-acquired pneumonia, and ventilator-associated pneumonia. Recent findings Over the past decade, the microbiological diagnosis of pneumonia ...
Source: Current Opinion in Pulmonary Medicine - April 2, 2020 Category: Respiratory Medicine Tags: INFECTIOUS DISEASES: Edited by Michael S. Niederman and Alimuddin Zumla Source Type: research

New biomarkers for respiratory infections
Purpose of review Although pneumonia, either community or hospital-acquired, is the most frequent severe respiratory infection, it is an infection difficult to diagnose. At present, the diagnosis of pneumonia relies on a combination of clinical, radiologic, and microbiologic criteria. However, these criteria are far from perfect leading to uncertainty in the diagnosis, risk stratification, and choice of antibiotic therapy. Biomarkers have been used to bring additional information in this setting. Recent findings The aim of this review is to provide a clear overview of the current evidence for biomarkers to distinguish...
Source: Current Opinion in Pulmonary Medicine - April 2, 2020 Category: Respiratory Medicine Tags: INFECTIOUS DISEASES: Edited by Michael S. Niederman and Alimuddin Zumla Source Type: research

Pneumococcal virulence factors in community-acquired pneumonia
Purpose of review This manuscript reviews the recent literature related to new developments in the understanding of existing and novel virulence factors of the pneumococcus that are of potential importance in the development of novel preventive and therapeutic strategies. Recent findings The pneumococcal capsule and pneumolysin have long been recognized as being two of the most prominent virulence factors, with much recent research having revealed previously unrecognized mechanisms by which they contribute to the pathogenesis of infection. Although the pneumococcal capsule has been considered a sine qua non for virule...
Source: Current Opinion in Pulmonary Medicine - April 2, 2020 Category: Respiratory Medicine Tags: INFECTIOUS DISEASES: Edited by Michael S. Niederman and Alimuddin Zumla Source Type: research

Influenza management with new therapies
We examined both pharmacological and supportive treatment strategies currently available to see how they might be applied in an ICU setting. Recent findings Supportive care in Influenza centres around optimizing respiratory failure, particularly through well established and recognized ventilatory strategies. Noninvasive ventilation and high-flow nasal oxygen may have a limited role in selected patients under carefully monitored circumstances. Drug therapy exerts only a modest clinical effect and has been poorly studied in the critically ill, though there is some evidence to support the use of neuraminidase inhibitors (N...
Source: Current Opinion in Pulmonary Medicine - April 2, 2020 Category: Respiratory Medicine Tags: INFECTIOUS DISEASES: Edited by Michael S. Niederman and Alimuddin Zumla Source Type: research

Viral respiratory infections: a cause of community-acquired pneumonia or a predisposing factor?
Purpose of review A cause for community-acquired pneumonia (CAP) is only identified in ∼50% of cases. Nasopharyngeal PCR panels contain more viruses than previously. The problem then becomes determining the relevance of the organisms identified rather than figuring out which virus is present. This review addresses how to distinguish between viral CAP and bacterial CAP, how viral CAP predisposes to bacterial CAP and some novel antiviral treatment being conducted. Recent findings The pneumonia severity index has been studied in patients with viral CAP. There are new studies using biomarkers to help determine when anti...
Source: Current Opinion in Pulmonary Medicine - April 2, 2020 Category: Respiratory Medicine Tags: INFECTIOUS DISEASES: Edited by Michael S. Niederman and Alimuddin Zumla Source Type: research