Bronchiectasis in adults: epidemiology, assessment of severity and prognosis
This article reviews the epidemiology, severity and impact of bronchiectasis in adults. Bronchiectasis is an increasingly recognised clinical syndrome characterised by bronchial dilatation on CT scanning in association with a history of cough, sputum production and/or recurrent respiratory infections. It may complicate a large number of underlying disorders and is increasingly recognised in association with other airway diseases, including COPD. Important considerations in the epidemiology of bronchiectasis include our limited knowledge of how to define the disease and therefore a lack of large-scale epidemiological studie...
Source: Current Respiratory Care Reports - August 3, 2015 Category: Respiratory Medicine Source Type: research
Role of broncho: alveolar lavage in approaching interstitial lung diseases
Abstract
Bronchoalveolar lavage (BAL) is a simple and safe procedure performed during flexible bronchoscopy. BAL provides an important diagnostic tool in the diagnosis of various diffuse lung diseases. BAL fluid analysis for cell count and differential, bacteriology and cytology may suggest specific disease or give alternative diagnosis. Nevertheless, BAL is seldom useful as a “stand-alone” diagnostic test for various diffuse pulmonary diseases. Confident diagnoses can be obtained when clinical evaluation and high-resolution computed tomography of the chest (HRCT) findings are combined with BAL fluid ...
Source: Current Respiratory Care Reports - July 29, 2015 Category: Respiratory Medicine Source Type: research
Biomarkers in interstitial lung disease: moving towards composite indexes and multimarkers?
Abstract
Interstitial lung disease (ILD) covers a large spectrum of lung disorders that affects the parenchyma and is often associated with inflammation and/or fibrosis. Clinically, there is a great need for biomarker development for these disorders, to help diagnosis, treatment selection and assessment of efficacy as well as to predict progression. Thus far, no broadly validated biomarker exists for ILD, due to the existence of a very large number of disorders of often-unknown etiology, overlapping symptoms and disorders associated with a spectrum of multi-morbidities involving similar chronic inflammato...
Source: Current Respiratory Care Reports - July 20, 2015 Category: Respiratory Medicine Source Type: research
The challenge of pulmonary nontuberculous mycobacterial infection
Abstract
The incidence of nontuberculous mycobacterial (NTM) lung disease is increasing. Current treatment strategies are largely based on expert opinion. The lack of randomized clinical trials to inform treatment leave clinicians with many questions regarding the most effective and safe regimens. The risk-benefit ratio of therapy is often thought to favor observation given the chronic nature of the disease, multiple long-term antibiotics recommended for therapy, side effects associated with treatment, and perceived lack of efficacious therapies. (Source: Current Respiratory Care Reports)
Source: Current Respiratory Care Reports - July 12, 2015 Category: Respiratory Medicine Source Type: research
Rheumatoid arthritis-associated interstitial lung disease
Abstract
Rheumatoid-associated interstitial lung disease (RA-ILD) is an important extra-articular manifestation of rheumatoid arthritis (RA), contributing to significant morbidity and mortality. Mortality is increased by 3-folds in RA-ILD patients in contrast with those without ILD. RA-ILD is frequently observed in males, and the risk of developing ILD is associated with older age at time of RA onset, male gender, and greater RA disease severity. Usual interstitial pneumonia (UIP) being the most common, with the worst prognosis. RA-ILD patients with UIP pattern tend to be older, more likely to be males, a...
Source: Current Respiratory Care Reports - July 10, 2015 Category: Respiratory Medicine Source Type: research
The role of serological testing in idiopathic interstitial pneumonia: a rheumatologist perspective
This article will highlight the importance of serological testing in patients with IIPs and the role of the rheumatologist in evaluating these patients. (Source: Current Respiratory Care Reports)
Source: Current Respiratory Care Reports - June 26, 2015 Category: Respiratory Medicine Source Type: research
Lung transplantation for pulmonary hypertension: management of pulmonary hypertension on the waiting list
Abstract
Despite the apparent improvement in outcomes for pulmonary arterial hypertension (PAH) with current medical therapy, for many patients, lung transplantation remains as an important therapeutic option. Such patients are at high risk for clinical deterioration while awaiting lung transplantation. Thus, the medical management is crucial to keep these tenuous patients acceptable on the waitlist. This includes optimization of PAH-targeted therapy and adjunctive therapies. For select patients, atrial septostomy may further expand the transplant window. Clinical deterioration of PAH, usually in the form...
Source: Current Respiratory Care Reports - May 26, 2015 Category: Respiratory Medicine Source Type: research
Mechanical ventilation for the lung transplant recipient
Abstract
Mechanical ventilation (MV) is an important aspect in the intraoperative and early postoperative management of lung transplant (LTx) recipients. There are no randomized-controlled trials of LTx recipient MV strategies; however, there are LTx center experiences and international survey studies reported. The main early complication of LTx is primary graft dysfunction (PGD), which is similar to the adult respiratory distress syndrome (ARDS). We aim to summarize information pertinent to LTx-MV, as well as PGD, ARDS, and intraoperative MV, and to synthesize these available data into recommendations. B...
Source: Current Respiratory Care Reports - April 25, 2015 Category: Respiratory Medicine Source Type: research
Environmental fine particular matter and airway epithelium cell stress
Abstract
Air pollution, especially the environmental particulate matter (PM), is known to have adverse effects on human health. The association between PM exposure and hospital admissions for COPD exacerbations has been widely reported. We focus on the effects of PM on airway epithelial cells and the role of oxidative stress in COPD. After exposure to PM2.5, oxidants and oxidative stress are increased in the epithelial cells. Increased oxidative stress plays an important role in COPD exacerbation by activating nuclear factor-kappaB (NF-kB) pathway. Oxidative stress also regulates epigenetic changes includ...
Source: Current Respiratory Care Reports - April 17, 2015 Category: Respiratory Medicine Source Type: research
Management of fungal infections in lung transplant recipients
Abstract
Lung transplantation is one of the great advances in modern medicine, and it is the only treatment for end-stage lung disease. As surgical techniques, immunosuppressive agents, and graft survival have improved, infections have become the major cause of morbidity and mortality among lung transplant recipients, particularly fungal infections. This paper provides an overview of the most important fungal infections that occur in lung transplant recipients excluding the endemic mycoses. (Source: Current Respiratory Care Reports)
Source: Current Respiratory Care Reports - April 16, 2015 Category: Respiratory Medicine Source Type: research
The updates of overlapping syndrome: asthma and COPD
Abstract
Asthma and chronic obstructive pulmonary disease (COPD) are highly prevalent chronic diseases in the general population. Both are characterized by heterogeneous chronic airway inflammation and airway obstruction. Airway obstruction is typically intermittent and reversible in asthma but is progressive and largely irreversible in COPD. However, there is a considerable pathologic and functional overlap between these two heterogeneous disorders, particularly among the elderly, who may have components of both diseases (asthma–COPD overlap syndrome, ACOS). A new chapter about ACOS is written in Globa...
Source: Current Respiratory Care Reports - April 14, 2015 Category: Respiratory Medicine Source Type: research
Understanding the lung allocation score for the non-transplant pulmonologist
Abstract
In order to better allocate scarce donor lung organs, the lung allocation score (LAS) was implemented in May 2005. The goals of the LAS were to reduce waiting list mortality of lung transplant candidates, to prioritize candidates based on medical urgency, and to maximize overall lung transplant benefit. Pre-transplant candidate variables are used to calculate waiting list survival, post-transplant survival, and transplant benefit measures. These measures produce a numerical lung allocation score between 0 and 100 with a higher score recipient receiving a greater priority ranking for donor lungs. ...
Source: Current Respiratory Care Reports - April 10, 2015 Category: Respiratory Medicine Source Type: research
Medical complications after lung transplantation
This article focuses on noninfectious, nonpulmonary medical complications seen postoperatively and discusses their impact on overall morbidity and mortality after lung transplantation. (Source: Current Respiratory Care Reports)
Source: Current Respiratory Care Reports - April 7, 2015 Category: Respiratory Medicine Source Type: research
Sleep-disordered breathing as a modifiable risk factor for cardiovascular disease
Abstract
Cardiovascular disease (CVD) remains the leading cause of disease-related death in most developed countries. Sleep-disordered breathing (SDB), including both obstructive sleep apnea (OSA) and central sleep apnea (CSA), are increasing in overall prevalence and are often found in patients with established CVD. This review article will first discuss the most current medical literature regarding the clinical correlation between OSA and major CVDs, including systemic hypertension, cardiac arrhythmias, coronary artery disease, pulmonary hypertension, and stoke, as well as the current evidence of the im...
Source: Current Respiratory Care Reports - March 10, 2015 Category: Respiratory Medicine Source Type: research
IgG4-related pleural disease
Abstract
IgG4-related disease (IgG4-RD) is a newly recognized chronic systemic fibroinflammatory disease that displays protean manifestations. Since the initial description of IgG4-related pancreatitis (type 1 autoimmune pancreatitis), it has become clear that IgG4-RD can involve virtually any organ in the human body including intrathoracic structures. It is characterized by infiltration of IgG4-positive plasma cells and fibrosis in affected organs. IgG4-RD affects mainly adults, more commonly men. Most commonly described form of pulmonary involvement is focal parenchymal opacities. However, other forms o...
Source: Current Respiratory Care Reports - February 8, 2015 Category: Respiratory Medicine Source Type: research
