Hard Metal Lung Disease: Update in Diagnosis and Management
AbstractPurpose of ReviewHard metal lung disease is a rare entity due to cobalt and tungsten carbide exposure. This review summarizes the literature focusing on pathogenesis, clinical features, diagnosis, and management.Recent FindingsTheories for pathogenesis include immunogenic activation, oxidant injury, and induction of hypoxia-inducible factor in macrophages. Multinucleated giant cells with bizarre cannibalistic features are the most common pathological finding; however, it is not pathognomonic. Corticosteroids remain the mainstay of treatment based on data from small studies.SummaryHard metal lung disease exposure ca...
Source: Current Respiratory Care Reports - May 4, 2020 Category: Respiratory Medicine Source Type: research

The Importance of Genetic Factors in the Management of Spontaneous Pneumothorax
AbstractPurpose of ReviewSpontaneous pneumothoraces can be the presenting phenotype in a variety of different syndromic genetic conditions. Respiratory physicians therefore have the opportunity to diagnose and manage these patients early to prevent serious complications associated with these syndromes.Recent FindingsThe genetic syndromes that present with pneumothoraces can be split broadly between those resulting from defective extracellular matrix formation and those caused by defective tumour-suppressor pathways. When connective tissues are weakened, lifelong surveillance for arterial dilatation can be life-saving as su...
Source: Current Respiratory Care Reports - April 20, 2020 Category: Respiratory Medicine Source Type: research

Human Cytomegalovirus Prophylaxis and Treatment in Lung Transplantation in the Current Era
This article sumarizes recent findings in the pathophysiology of HCMV, especially its effects in lung transplant recipients; the current and new modalities for treatment and prevention of infection; and the latest guidelines for prevention and management of HCMV in lung transplant recipients.Recent FindingsRecent findings include moves towards standardization for monitoring and treating HCMV and approval of a new agent, letermovir, for prevention of HCMV reactivation in hematopoietic cell transplant recipients now in clinical trials for solid organ transplant recipients, and updates on the late stage development of maribav...
Source: Current Respiratory Care Reports - February 22, 2020 Category: Respiratory Medicine Source Type: research

Eosinophilic vs. Neutrophilic Asthma
AbstractPurpose of ReviewUnderstanding the molecular mechanisms and heterogeneity of asthma has allowed the discovery of two distinct endotypes based on the mechanisms driving the underlying airway inflammation: eosinophilic asthma, a subtype of T2-high asthma, and neutrophilic asthma, a subtype of non-T2 asthma or T2-low asthma. In this review, we highlight the current knowledge about the immunopathology of these distinct subtypes and their clinical and therapeutic implications.Recent FindingsThe intricate interplay of immune pathways has been recently evaluated in both eosinophilic and neutrophilic asthma. The delineatio...
Source: Current Respiratory Care Reports - February 13, 2020 Category: Respiratory Medicine Source Type: research

Donor-Derived Disease Transmission in Lung Transplantation
AbstractPurpose of ReviewUnderstanding the risk of donor-derived infection, particularly in the lung transplant population, should reduce discarding organs without risk. Ongoing regulatory efforts and improved clinician awareness can help improve organ supply and post-transplantation outcomes.Recent FindingsInfections can be divided into expected and unexpected. Syndromes that manifest in the early-post-transplant period should raise concern of a donor-derived transmission. Emerging data suggests that donors with certain bacterial infections can be safely used while donors with HCV infection can be a useful source of previ...
Source: Current Respiratory Care Reports - January 30, 2020 Category: Respiratory Medicine Source Type: research

Update on Management of Pleural Disease
AbstractPurpose of reviewThe goal of this paper is to review and summarize the most recent updates in the management of both benign and malignant pleural diseases.Recent findingsMultiple trials evaluating the use of non-surgical techniques for the management of pleural infection have been published in the last 5 years. Additionally, the use of tunneled pleural catheter (TPC) placement in the management of non-infectious recurrent pleural effusions is being increasingly studied. Finally, the separate use of TPC placement or talc pleurodesis as well as a combined rapid pleurodesis protocol involving both talc poudrage and TP...
Source: Current Respiratory Care Reports - December 13, 2019 Category: Respiratory Medicine Source Type: research

Bronchoscopy: Past, Present, and Future
AbstractPurpose of ReviewTo review the history of the bronchoscope and how pulmonologists have implemented it in clinical practice. Bronchoscopy has changed more in the last 20 years than in the previous century. The role of the pulmonologist has changed with the evolution of technology.Recent FindingsOver the last 20 years, endobronchial ultrasound and electromagnetic navigation have been employed in the diagnosis and staging of lung cancer. Most recently, robotic technology has been incorporated in bronchoscopy to provide enhanced stability, flexibility, and reach.SummaryBronchoscopy has emerged as a minimally invasive t...
Source: Current Respiratory Care Reports - December 10, 2019 Category: Respiratory Medicine Source Type: research

Hemoptysis: Rethinking Management
AbstractPurpose of ReviewHemoptysis is a distressing symptom that necessitates urgent investigation. Despite its prevalence, there is frequent uncertainty regarding the etiology, clinical trajectory, and therapeutic management of hemoptysis. We aim to discuss the causes, diagnostic workup, and pragmatic management strategies for cases of massive and non-massive hemoptysis.Recent FindingsBronchoscopic techniques to control hemoptysis is an emerging area of study. Fogarty balloons and endobronchial blockers are often deployed to isolate the bleeding lung. Depending on the source of bleeding, a variety of endobronchial medica...
Source: Current Respiratory Care Reports - December 7, 2019 Category: Respiratory Medicine Source Type: research

Hypersensitivity Pneumonitis (Including Environmental Assessment): Diagnosis and Management
This article aims to provide an overview on the diagnosis and management of hypersensitivity pneumonitis (HP). We will focus on the issues surrounding the lack of an international consensus on the diagnosis of HP, and review the existing treatment options for HP.Recent FindingsThere is emerging international consensus that HP should be classified based on clinical, radiologic, and pathologic features and not solely on disease duration. Environmental assessment and antigen avoidance remains the most important step in managing HP. Antifibrotics may soon become a viable option for chronic HP in the near future. Well-designed ...
Source: Current Respiratory Care Reports - December 4, 2019 Category: Respiratory Medicine Source Type: research

The Spectrum of Drug-Induced Interstitial Lung Disease
AbstractPurpose of ReviewDrug-induced interstitial lung disease (DI-ILD) is a very challenging topic both clinically and academically. With the advent of new immunotherapy and ever-growing arsenal of chemotherapeutic and biologic agents for a variety of conditions, it is paramount for the clinician to assess for the development of pulmonary toxicity before irreversible lung damage occurs. In this review, we have summarized the literature and describe the most commonly implicated agents and also describe new and rare causes of DI-ILD.Recent FindingsBleomycin and amiodarone remain the most frequent culprits of DI-ILD. Protea...
Source: Current Respiratory Care Reports - December 3, 2019 Category: Respiratory Medicine Source Type: research

Bronchoscopic Lung Volume Reduction Using Endobronchial Valves: How to Do It
AbstractPurpose of ReviewChronic obstructive pulmonary disease (COPD) is the third leading cause of mortality worldwide. Over the last decade, many studies have validated the use of endobronchial valves (EBVs) for bronchoscopic lung volume reduction (BLVR) in patients who are persistently symptomatic despite optimal medical therapy. We aimed to review the literature and describe appropriate patient selection and procedural considerations.Recent FindingsBLVR using EBVs leads to an improvement in FEV1, 6-min walk distance, and health-related quality of life. Two valve systems have recently obtained FDA approval for use for t...
Source: Current Respiratory Care Reports - December 2, 2019 Category: Respiratory Medicine Source Type: research

Photodynamic Therapy and Its Use in Lung Disease
AbstractPurpose of ReviewPhotodynamic therapy is approved in the USA for curative treatment of microinvasive endobronchial non-small cell lung cancer and palliation of symptoms with obstructing endobronchial non-small cell lung cancer. New data support its use with positive margins after surgical resection. Emerging data suggest it is both safe and efficacious for use in the periphery with non-small cell lung cancer.Recent FindingsSeveral case series have demonstrated its utility with endobronchial disease from small cell lung cancer. Recent studies have examined its use with recurrent respiratory papillomatosis, adenoid c...
Source: Current Respiratory Care Reports - November 28, 2019 Category: Respiratory Medicine Source Type: research

Role of New Imaging Capabilities with MRI and CT in the Evaluation of Bronchiectasis
AbstractPurpose of ReviewBronchiectasis is the permanent abnormal dilation of the airways and can be associated with various pathogeneses and outcomes. Proper diagnosis and evaluation of bronchiectasis employs x-ray CT, though emerging research has also shown MRI to be sensitive to the disease. The goal of this article is to review recent research in CT and MRI of bronchiectasis and associated diseases.Recent FindingsTechniques in quantitative CT continue to improve and may improve consistency in bronchiectasis evaluation and reduce reader scoring load. While CT is the “gold standard” for evaluation of bronchie...
Source: Current Respiratory Care Reports - November 26, 2019 Category: Respiratory Medicine Source Type: research

Acute Exacerbation of Idiopathic Pulmonary Fibrosis: Who to Treat, How to Treat
AbstractPurpose of ReviewAcute exacerbations of idiopathic pulmonary fibrosis (AE-IPF) are the most frequent cause of death among patients with IPF. Here, we review the revised definition and diagnostic criteria for AE-IPF and discuss management strategies including mechanistically targeted investigational therapies for this complex syndrome.Recent FindingsNovel therapies targeting various pathways including inflammation, autoimmunity, and coagulation cascade involved in AE-IPF have recently been reported. Although most of these reports are small and uncontrolled, they have provided evidence to design larger randomized, co...
Source: Current Respiratory Care Reports - November 26, 2019 Category: Respiratory Medicine Source Type: research

Duration of Antibiotic Therapy in Non-cystic Fibrosis Bronchiectasis
AbstractPurpose of ReviewWe conducted a review of the current evidence relating to antibiotic duration in the short- and long-term management of non-cystic fibrosis bronchiectasis.Recent FindingsIn non-cystic fibrosis pulmonary exacerbations, evidence is primarily based on expert consensus and recent guidelines recommend antibiotic durations of approximately 14  days. Chronic antibiotics (oral or inhaled) are recommended in patients with frequent exacerbations or with chronicPseudomonas aeruginosa airways infection. Macrolides are the best studied therapies for long-term use with evidence for effect limited to a 12-mo...
Source: Current Respiratory Care Reports - November 26, 2019 Category: Respiratory Medicine Source Type: research

Nontuberculous Mycobacteria Infection: Source and Treatment
AbstractPurpose of ReviewThis review offers current understanding of the source of nontuberculous mycobacteria (NTM) infections especially in relation to engineered water systems. It provides a summary of current treatment methods and highlights novel treatment options being developed.Recent FindingsNontuberculous mycobacteria (NTM) infections are thought to originate from inhalation or aspiration of NTM from contaminated drinking water. While significant NTM metagenomics analysis and culturing of environmental samples have been performed, the bias of culture independent and dependent techniques along with the ubiquity of ...
Source: Current Respiratory Care Reports - November 26, 2019 Category: Respiratory Medicine Source Type: research

Imaging Pulmonary Embolic Disease
AbstractPurpose of ReviewThe purpose of this article is to review the imaging findings and current imaging techniques of acute pulmonary embolism (PE) and chronic thromboembolic disease. Special considerations are also discussed, including pregnancy, congenital heart disease, lower extremity computed tomography (CT), and the isolated subsegmental PE.Recent FindingsCT pulmonary angiography and planar ventilation/perfusion (V/Q) lung scintigraphy are the primary means of evaluating pulmonary embolic disease. Magnetic resonance angiography avoids ionizing radiation and iodinated contrast in select patients. V/Q SPECT/CT provi...
Source: Current Respiratory Care Reports - July 30, 2019 Category: Respiratory Medicine Source Type: research

Lung Nodule: Imaging Features and Evaluation in the Age of Machine Learning
AbstractPurpose of ReviewWith the unprecedented increase in chest CT studies, especially due to implementation of lung cancer screening, evaluation of lung nodules by radiologists can be exhausting and time-consuming. Machine learning promises to be a useful tool for detection and characterization of nodules. The purpose of this review is to evaluate the recent literature pertaining to machine learning in lung nodule detection and evaluation.Recent FindingsThere has been a recent surge of publications pertaining to machine learning and its applications in chest imaging. Many studies have shown promising results for automat...
Source: Current Respiratory Care Reports - July 22, 2019 Category: Respiratory Medicine Source Type: research

A New Approach to Pleural Infection: Let It Be?
AbstractPurpose of ReviewThe incidence of pleural infection is increasing, and there remain many challenges to managing this condition. This review provides a synthesised overview of the current state of knowledge and identifies key areas for future research.Recent FindingsRecent studies have broadened our understanding of pleural microbiology and the natural history of pleural infection. The development and evolution of intrapleural fibrinolytic therapy have established three separate treatment options in pleural infection. This has led to the development of new management algorithms and re-examined the role of surgery. S...
Source: Current Respiratory Care Reports - July 17, 2019 Category: Respiratory Medicine Source Type: research

Imaging Cystic Lung Disease
AbstractPurpose of ReviewCystic lung disease is characterized by multiple air-filled spaces in the lung. Pulmonary cysts occur in a variety of diseases, including infectious, inhalational, genetic, and neoplastic conditions. The purpose of this report is to review the CT imaging patterns and appearances of the most common cystic lung diseases, and to highlight the differences between different cystic lung diseases and the unique qualities related to each condition.Recent FindingsCommon cystic lung diseases include lymphangioleiomyomatosis, pulmonary Langerhans cell histiocytosis, lymphocytic interstitial pneumonia, desquam...
Source: Current Respiratory Care Reports - July 16, 2019 Category: Respiratory Medicine Source Type: research

Tracheobronchomalacia in the Adult: Is Imaging Helpful?
AbstractPurpose of ReviewThe aim of this article is to: 1) Review the imaging features of tracheobronchomalacia and excessive dynamic airway collapse 2) To highlight the recent advances in imaging of the central airways.Recent FindingsImaging of the central airways requires dedicated techniques optimized to evaluate the transient collapse of the central airways either due to excessive movement of the posterior membrane and/or secondary to weakness of the tracheal cartilages. Routine imaging of the chest is limited in its ability to demonstrate the true extent of collapsibility of the airways. The more recently introduced i...
Source: Current Respiratory Care Reports - July 16, 2019 Category: Respiratory Medicine Source Type: research

Lung Cancer Screening: Insights from a Thriving Clinical Practice
AbstractPurpose of ReviewLung cancer is the leading cause of cancer deaths in the USA. Computed tomography (CT) offers the potential for early detection by screening asymptomatic high-risk patients. We aimed to review the benefits and potential harms of lung cancer screening, discuss the logistics of a screening program, and provide insight from our own experience.Recent FindingsThe National Lung Screening Trial (NLST), a large population-based study, has demonstrated mortality benefit from screening, but relatively few eligible patients currently participate. An effective screening program requires input and cooperation f...
Source: Current Respiratory Care Reports - July 11, 2019 Category: Respiratory Medicine Source Type: research

Refractory Chylothorax: Where Do We Go Now?
AbstractPurpose of ReviewThe purpose of this review is to discuss the efficacy and safety of recently introduced diagnostic procedures and radiological interventions for the treatment of chylothorax and their integration into classic strategies such as dietetic measures, the use of octreotide and its analogues and surgery.Recent FindingsTo date, there are no published validated algorithms to guide chylothorax treatment with the majority of evidence predominantly derived from case series.SummaryAlthough radiological interventions appear viable and safe, they are currently available in only a small number of centres. When co...
Source: Current Respiratory Care Reports - May 24, 2019 Category: Respiratory Medicine Source Type: research

Malignant Pleural Mesothelioma: an Update for Pulmonologists
AbstractPurpose of ReviewMalignant pleural mesothelioma (MPM) is an incurable disease, and its global incidence is predicted to rise. The epidemiology is changing especially in developed countries where the increases in incidence centers around the older age group. Pulmonologists are the frontline specialists faced with the challenges of diagnosing MPM and management of the associated respiratory issues, especially malignant pleural effusions. Although much of recent literature surrounds treatment of MPM, this review highlights latest developments in aspects of MPM care relevant to pulmonologists ’ practice.Recent Fi...
Source: Current Respiratory Care Reports - May 2, 2019 Category: Respiratory Medicine Source Type: research

Pleurotoxic Drugs —an Update: Someone Else to Blame?
AbstractPurpose of ReviewTo provide an updated summary of the pleurotoxic drugs and their manifestations.Recent FindingsNovel antineoplastic agents for the treatment of hematologic and non-hematologic malignancies have been associated with the induction of pleural disorders. Moreover, the list of agents that have been associated with drug-induced lupus pleuritis is steadily increasing.SummaryPleurotoxic medications are agents that may cause pleural disorders, most commonly pleural effusions. Connecting a pleural disorder to a specific drug requires the exclusion of other potential causes combined with resolution of the dis...
Source: Current Respiratory Care Reports - April 26, 2019 Category: Respiratory Medicine Source Type: research

Obesity Hypoventilation: Pathophysiology, Diagnosis, and Treatment
AbstractPurpose of ReviewThis is a review of the current understanding of the pathophysiology behind the development of daytime hypercapnia in a subset of obese patients. It provides an overview of the recent evidence to guide physicians in the diagnosis and treatment of patients with obesity hypoventilation syndrome (OHS).Recent FindingsOHS results from a complex interplay between obesity-related changes in respiratory mechanics, sleep-disordered breathing, changes in central ventilatory drive, and neurohormonal changes. Diagnosis is important given the associated morbidity, but reliance on a single measurement of PaCO2 o...
Source: Current Respiratory Care Reports - April 11, 2019 Category: Respiratory Medicine Source Type: research

Central Sleep Apnea: a Brief Review
AbstractPurpose of ReviewThe purpose of this review is to discuss the pathogenesis, clinical manifestations, diagnosis, and treatment, including areas of controversy and uncertainty.Recent FindingsCentral apnea may be due to hypoventilation or to hypocapnia following hyperventilation. The occurrence of central apnea initiates a cascade of events that perpetuates breathing instability, recurrent central apnea, and upper airway narrowing. In fact, breathing instability and upper airway narrowing are key elements of central and obstructive apnea. Clinically, central apnea is noted in association with obstructive sleep apnea, ...
Source: Current Respiratory Care Reports - March 13, 2019 Category: Respiratory Medicine Source Type: research

Screening for Obstructive Sleep Apnea: Should We Do It?
AbstractPurpose of ReviewObstructive sleep apnea (OSA) is prevalent and underdiagnosed. It is associated with significant comorbidities and early detection and treatment might lead to improvement in important clinical outcomes. This paper will review current evidence on screening for OSA in the primary care setting and in certain high-risk groups.Recent FindingsThe 2017 United States Preventative Services Taskforce evidence review on OSA screening noted a lack of high-quality evidence linking OSA screening with important clinical outcomes and on the accuracy of proposed screening tools.SummaryOSA symptoms are usually not d...
Source: Current Respiratory Care Reports - February 4, 2019 Category: Respiratory Medicine Source Type: research

Improving Adherence to PAP Therapy: an Update
AbstractPurpose of ReviewPositive airway pressure (PAP) therapy is the “gold standard” of treatment for obstructive sleep apnea; however, rates of non-adherence to PAP therapy remain high despite device improvements and the inclusion of PAP education programs in most comprehensive sleep disorders clinics. We aimed to review recent evidence-based trends for improvin g PAP adherence.Recent FindingsRemote monitoring and telemedicine interventions in conjunction with mobile patient engagement applications have shown promise in facilitating uptake and maintenance of PAP use. New focus on the bedpartner dyad and mana...
Source: Current Respiratory Care Reports - February 1, 2019 Category: Respiratory Medicine Source Type: research

Pneumonitis in Patients with Lung Cancer Following Treatment: the Effects of Chemotherapy, Immunotherapy, and Tyrosine Kinase Inhibitors
AbstractPurpose of ReviewMultiple articles have been written on the development of pneumonitis as it relates to each class of treatment options in NSCLC. To date, there are no articles that review pulmonary side effects seen in all agents including chemotherapy, immunotherapy, and TKIs that are used in NSCLC. Our goal was to identify these agents, review the pathophysiology, and establish treatment options when pneumonitis develops. In doing so, we have established a resource for physicians treating this disease.Recent FindingsWithin the past decade, significant strides have been made in the treatment of patients with adva...
Source: Current Respiratory Care Reports - November 13, 2018 Category: Respiratory Medicine Source Type: research

The Changing Paradigm of Treatment for Non-Small Cell Lung Cancer Intracranial Metastases
AbstractPurpose of ReviewEvaluate safety and efficacy of newer systemic therapies for intracranial metastases (IM) from non-small cell lung cancer (NSCLC) when given alone and with concurrent radiation therapy (RT) and determine which patients with IM may benefit from upfront systemic therapy while withholding RT.Recent FindingsIn NSCLC, chemotherapy regimens are associated with approximately 20% intracranial overall response rates (ORRs) and immunotherapies 30 –50% intracranial ORRs. However, tyrosine kinase inhibitor (TKI) therapies for EGFR-mutated patients provide ORRs ranging from 50 to 90%. Prospective data sug...
Source: Current Respiratory Care Reports - November 9, 2018 Category: Respiratory Medicine Source Type: research

The Diagnostic Approach to Interstitial Lung Disease
AbstractPurpose of ReviewInterstitial lung diseases are a heterogeneous group of disorders characterized by varying degrees of inflammation and scarring of the lung parenchyma. Diagnosis can be challenging and requires careful multidisciplinary appraisal of carefully obtained history, physical examination, serological profile, imaging, and, at times, lung tissue. We aim to provide a roadmap for the diagnosis of ILD.Recent FindingsThe diagnostic criteria for IPF, which is the deadliest form of idiopathic interstitial pneumonia, and HRCT pattern classification have been updated. Transbronchial cryobiopsies are becoming more ...
Source: Current Respiratory Care Reports - October 29, 2018 Category: Respiratory Medicine Source Type: research

Approved and Experimental Therapies for Idiopathic Pulmonary Fibrosis
AbstractPurpose of ReviewTreatment of idiopathic pulmonary fibrosis (IPF) shifted significantly in the past few years, in the light of advances in understanding pathological pathways. The promising results coming from recent trials led to a growing number of studies dealing with IPF. The purpose of this article is to review scientific evidences supporting approved therapies and to provide an overview of experimental treatments that are currently under investigation.Recent FindingsApproved anti-fibrotic treatments are based on large randomized trials showing the efficacy of pirfenidone and nintedanib in slowing IPF progress...
Source: Current Respiratory Care Reports - October 29, 2018 Category: Respiratory Medicine Source Type: research

The Use and Interpretation of Impedance Oscillometry in Pulmonary Disorders
AbstractPurposeChronic respiratory diseases are prevalent among adults and lung function testing is imperative for appropriate diagnosis and treatment. While spirometry is the standard measure of lung function, there exist groups of individuals unable to adequately perform accurate and reproducible lung function testing. Impedance oscillometry system (IOS) is an effort independent test that may be employed to assess airway function in challenging groups such as children and elderly. This review will compare IOS and spirometry and describe the physiologic measurements of lung function and interpretation strategies in adults...
Source: Current Respiratory Care Reports - October 29, 2018 Category: Respiratory Medicine Source Type: research

Assessment of Symptoms in Patients with COPD: Strengths and Limitations of Clinical Scores
AbstractPurpose of ReviewHealth questionnaires are valuable tools to quantify, in an objective and standardised manner, the impact of chronic obstructive pulmonary disease on the health status of patients and on their well-being, and to track changes over time. Therefore, filling out these questionnaires allows clinicians to obtain the necessary information that can be easily related to clinical outcomes.Recent FindingsMost importantly, symptoms ’ assessment represents a very relevant part of these clinical tools when applied to patients suffering from chronic respiratory diseases. Comparing scores between visits is ...
Source: Current Respiratory Care Reports - October 27, 2018 Category: Respiratory Medicine Source Type: research

Early Graft Dysfunction After Lung Transplantation
AbstractPurpose of ReviewPrimary graft dysfunction is an acute lung injury syndrome occurring immediately following lung transplantation. This review aims to provide an overview of the current understanding of primary graft dysfunction (PGD), including epidemiology, immunology, clinical outcomes, and management.Recent FindingsIdentification of donor and recipient factors allowing accurate prediction of PGD has been actively pursued. Improved understanding of the immunology underlying PGD has spurred interest in identifying relevant biomarkers. Work in PGD prediction, severity stratification, and targeted therapies continue...
Source: Current Respiratory Care Reports - October 22, 2018 Category: Respiratory Medicine Source Type: research

Nonpharmacological Therapies for Interstitial Lung Disease
AbstractPurpose of ReviewInterstitial lung diseases (ILDs) cause unpredictable degrees of fibrosis and inflammation in the lungs leading to functional decline and varying symptom burden for patients. Some patients may live for years and be responsive to therapy, and other disease trajectory may be shorter and similar to patients with lung cancer. This ultimately affects the patient ’s quality of life as well as their caregiver(s).Recent FindingsNonpharmacological therapies play an important role in treatment of interstitial lung disease. These include symptom management, pulmonary rehabilitation, oxygen therapy, and ...
Source: Current Respiratory Care Reports - October 18, 2018 Category: Respiratory Medicine Source Type: research

Evidence-Based Assessment of Bronchial Thermoplasty in Asthma: Mechanisms and Outcomes
AbstractPurpose of ReviewAsthma is a heterogenous, chronic respiratory disease characterized by airway inflammation, obstruction, and hyperresponsiveness that results in debilitating respiratory symptoms. Despite advances in management strategies, severe asthmatics are often not responsive to the standard management and are disproportionately impacted. Bronchial thermoplasty offers a treatment option for this subgroup of severe asthmatics.Recent FindingsMultiple clinical studies have examined bronchial thermoplasty effectiveness and safety in severe asthma. Recent post-market and translational studies have brought new insi...
Source: Current Respiratory Care Reports - October 17, 2018 Category: Respiratory Medicine Source Type: research

Risk Factors for the Development of Idiopathic Pulmonary Fibrosis: a Review
AbstractPurpose of ReviewIdiopathic pulmonary fibrosis (IPF) is an invariably progressive disease. Current treatment options simply slow disease progression, and better therapeutic options are needed. We aimed to review an emerging literature on risk factors associated with the development of IPF.Recent FindingsThere is increasing data to support the role of intrinsic risk factors (e.g., genetics, aging, sex, lung microbiome), comorbidities (e.g., gastroesophageal reflux, obstructive sleep apnea, diabetes mellitus, herpes virus infection), and extrinsic risk factors (e.g., cigarette smoking, environmental exposures, air po...
Source: Current Respiratory Care Reports - October 16, 2018 Category: Respiratory Medicine Source Type: research

Connective Tissue Related Interstitial Lung Disease
AbstractPurpose of ReviewInterstitial lung disease (ILD) is a common complication of the connective tissue diseases (CTD) and results in significant morbidity and mortality. This review will focus on recent literature pertaining to the epidemiology, clinical presentation, diagnosis, and treatment of CTD-ILD.Recent FindingsSubclinical ILD can be found in the majority of patients with CTD. Clinically significant ILD is most commonly seen in scleroderma followed by polymyositis/dermatomyositis and rheumatoid arthritis, although it can occur in all of the CTDs. Nonspecific interstitial pneumonia is the most common radiographic...
Source: Current Respiratory Care Reports - October 8, 2018 Category: Respiratory Medicine Source Type: research

Chronic Lung Allograft Dysfunction
AbstractPurpose of ReviewSynthesize recent developments in the understanding of chronic lung allograft dysfunction (CLAD) epidemiology, pathophysiology, outcomes, and treatments with a focus on the classification of CLAD into restrictive allograft syndrome (RAS) and from bronchiolitis obliterans syndrome (BOS).Recent FindingsChronic lung allograft dysfunction (CLAD) remains the leading cause of long-term morbidity and mortality in lung transplant recipients. Despite the lack of progress on improving outcomes, significant progress has been made in better characterizing the disease ’s clinical and pathologic diversity....
Source: Current Respiratory Care Reports - October 2, 2018 Category: Respiratory Medicine Source Type: research

Lung Transplantation in Connective Tissue Disease-Associated Interstitial Lung Disease (CTD-ILD)
AbstractPurpose of ReviewConnective tissue disease-related interstitial lung disease (CTD-ILD) previously was a relative contraindication to lung transplantation primarily due to extra-pulmonary involvement of the disease. Recent published information focusing on the diagnosis and management of the extra-pulmonary complexities associated with CTD-ILD that challenge the success of lung transplantation indicate similar outcomes when compared to idiopathic causes of interstitial lung disease. Recent literature examining appropriate wait-listing criteria, disease management, and outcomes after lung transplantation are discusse...
Source: Current Respiratory Care Reports - September 20, 2018 Category: Respiratory Medicine Source Type: research

Rising to the Challenge of Unmet Need: Expanding the Lung Donor Pool
AbstractPurpose of ReviewThere is a shortage of lungs available to meet the needs of patient who require lung transplantation. Ex vivo lung perfusion (EVLP) has allowed for the assessment and reconditioning of extended criteria and high-risk donor lungs, allowing for an increased volume of lung transplants. Recently, an invested interest in the utilization donation after cardiac death (DCD) donors has surfaced, in which EVLP has played an important role.Recent FindingsClinical studies have shown that EVLP can recondition donor lungs that initially would be unacceptable for transplantation. In a recent study, the interventi...
Source: Current Respiratory Care Reports - September 1, 2018 Category: Respiratory Medicine Source Type: research

Risk of Development of Resistance in Patients with Non-Cystic Fibrosis Bronchiectasis Treated with Inhaled Antibiotics
AbstractPurpose of ReviewBronchiectasis is a debilitating chronic lung disease characterised by recurrent bacterial infection and colonisation with significant associated morbidity and mortality. To date, there are few licenced treatments, and the mainstay of clinical management is prompt antibiotic therapy for exacerbations and regular airway clearance. Inhaled antibiotics are a potential long-term treatment for those with recurrent exacerbations, and represent an obvious advantage over other routes of administration as they achieve high concentrations at the site of infection whilst minimising systemic side effects. The ...
Source: Current Respiratory Care Reports - September 1, 2018 Category: Respiratory Medicine Source Type: research

Treatment of Advanced Non-Small Cell Lung Cancer in the Era of Targeted Therapy
AbstractPurpose of ReviewSince the identification of multiple mutations associated with advanced non-small cell lung cancer (NSCLC), many targeted therapies have been developed for the treatment of this subgroup of lung cancers. These targeted therapies have changed the landscape of lung cancer treatment when compared to standard chemotherapy, with improved survival and quality of life. In this review article, we will review the major mutations associated with advanced NSCLC, namely EGFR, ALK, and ROS1. We will discuss their discovery, their clinical significance, and the diagnostic tests used for their detection. We will ...
Source: Current Respiratory Care Reports - September 1, 2018 Category: Respiratory Medicine Source Type: research

It's What ’s Inside that Counts: Body Composition and Lung Transplantation
AbstractPurpose of ReviewFactors such as weight, body composition, and functional status appear to influence lung transplant outcomes. Body mass index (BMI) is incorporated into the International Society for Heart and Lung Transplantation ’s (ISHLT) recipient selection guidelines. Data suggests BMI does not effectively differentiate patients with high body fat percentage or low lean muscle mass, leading to both over and under estimates of candidates’ risks.Recent FindingsRecent research has focused on alternate measures and estimates of body composition and their associations with important lung transplant outc...
Source: Current Respiratory Care Reports - September 1, 2018 Category: Respiratory Medicine Source Type: research

Risk of Bacterial Transmission in Bronchiectasis Outpatient Clinics
AbstractPurpose of ReviewThe purpose of this review is to discuss the risk of bacterial cross-infection for bronchiectasis patients in the outpatient setting. Cross-infection has primarily been a matter of concern in cystic fibrosis (CF). There is considerable evidence of transmission of pathogens between CF patients, and this has led to guideline recommendations advocating strict segregation policies. Guidelines in bronchiectasis do not specifically address the issue of cross-infection. If cross-infection is prevalent, it may have significant implications for patients and the practical running of specialist care.Recent Fi...
Source: Current Respiratory Care Reports - September 1, 2018 Category: Respiratory Medicine Source Type: research

Rising to the Challenge of Unmet Need: Expanding the Lung Donor Pool
AbstractPurpose of ReviewThere is a shortage of lungs available to meet the needs of patient who require lung transplantation. Ex vivo lung perfusion (EVLP) has allowed for the assessment and reconditioning of extended criteria and high-risk donor lungs, allowing for an increased volume of lung transplants. Recently, an invested interest in the utilization donation after cardiac death (DCD) donors has surfaced, in which EVLP has played an important role.Recent FindingsClinical studies have shown that EVLP can recondition donor lungs that initially would be unacceptable for transplantation. In a recent study, the interventi...
Source: Current Respiratory Care Reports - August 11, 2018 Category: Respiratory Medicine Source Type: research