Sleep disorders in COPD
Abstract
In patients with chronic obstructive pulmonary disease (COPD, defined as a combination of emphysema and chronic bronchitis), sleep quality and architecture are often altered. The very common nocturnal symptoms of cough, dyspnea, chest tightness, and wheezing disturb sleep and lead to daytime dissatisfaction and additional symptoms in these patients. Sleep is often fragmented, while rapid eye movement sleep is generally diminished in duration. Due to nocturnal symptoms and possibly the use of certain medications, some patients with COPD experience difficulty initiating or maintaining sleep, sympto...
Source: Current Respiratory Care Reports - February 4, 2015 Category: Respiratory Medicine Source Type: research
Obesity hypoventilation syndrome
Abstract
Obesity hypoventilation syndrome is a respiratory consequence of morbid obesity that is characterized by alveolar hypoventilation during sleep and wakefulness. The disorder involves a complex interaction between impaired respiratory mechanics, ventilatory drive, and sleep-disordered breathing. Early diagnosis and treatment is important because delay in treatment is associated with significant mortality and morbidity. Available treatment options include noninvasive positive airway pressure (PAP) therapies and weight loss. There is limited long-term data regarding the effectiveness of such therapie...
Source: Current Respiratory Care Reports - January 31, 2015 Category: Respiratory Medicine Source Type: research
Discovery of new biomarkers for malignant mesothelioma
Abstract
Malignant mesothelioma is an asbestos-induced, aggressive tumour with limited treatment options and very poor outcome. Currently, there are no tumour biomarkers in widespread clinical use for this disease. Soluble mesothelin is the most intensively investigated mesothelioma biomarker and has been approved by the US FDA primarily as a tool for monitoring patient response and progression. Mesothelin is elevated in the blood and effusions of patients with mesothelioma, and is rarely elevated in people with benign disease with normal renal function. However, the sensitivity of mesothelin limits its u...
Source: Current Respiratory Care Reports - January 31, 2015 Category: Respiratory Medicine Source Type: research
Adjunct strategies to enhance the efficacy of indwelling pleural catheters
This article reviews the current data available for “rapid” and “accelerated” pleurodesis protocols and their outcomes. (Source: Current Respiratory Care Reports)
Source: Current Respiratory Care Reports - January 29, 2015 Category: Respiratory Medicine Source Type: research
Indwelling pleural catheters
Abstract
Indwelling pleural catheters (IPCs) are increasingly used in clinical practice. They are often accepted as a first-line treatment option for patients with malignant pleural effusion. IPCs are inserted as a day case and afford patients autonomous relief of symptoms in the outpatient setting. They also offer scope for ongoing study, monitoring and treatment of malignant pleural effusion, as well as a role in benign effusion management. This paper provides an overview of the rationale and principles of IPC use, describing practical aspects and outlining potential future developments destined to addr...
Source: Current Respiratory Care Reports - January 27, 2015 Category: Respiratory Medicine Source Type: research
Chemical pleurodesis for first presentation of primary spontaneous pneumothorax
Abstract
Primary spontaneous pneumothorax (PSP) most commonly occurs in young, tall, lean males. The PSP recurrence rate varies between 16 and 52 % after the first episode. This high recurrence rate has stimulated the development of different therapeutic approaches, ranging from simple aspiration to invasive therapies, including chemical pleurodesis or surgery. Chemical pleurodesis is a procedure which uses sclerosing agents to cause adhesion between the two layers of the pleura. Traditionally, chemical pleurodesis for PSP has been recommended only if the patient is unwilling or unable to undergo surgery...
Source: Current Respiratory Care Reports - January 27, 2015 Category: Respiratory Medicine Source Type: research
Legalizing Cannabis: A physician’s primer on the pulmonary effects of marijuana
Abstract
Habitual smoking of marijuana is associated with multiple respiratory symptoms such as cough, sputum production, and wheezing .These symptoms are not significantly different from those exhibited by tobacco smokers. Furthermore, endobronchial biopsies of habitual smokers of marijuana and /or tobacco have shown that both marijuana and cigarette smoking cause significant bronchial mucosal histopathology and that these effects are additive. Although marijuana smokers have minimal changes in pulmonary function studies as compared to tobacco smokers, they may develop bullous disease and spontaneous pne...
Source: Current Respiratory Care Reports - October 11, 2014 Category: Respiratory Medicine Source Type: research
Diagnosis and management of nontuberculous mycobacterial lung infections
Abstract
The diagnosis and management of nontuberculous mycobacterial (NTM) lung infection remains difficult even among experienced clinicians. Both the incidence and prevalence are likely expected to rise with an aging population. Careful assessment of clinical, radiologic, and microbiologic studies is warranted before initiating therapy, which is often complicated by significant drug side effects and limited sputum conversion rates. Indications to treat are best based on a number of factors, including specific NTM species, NTM lung-infection–associated symptoms, advanced bronchiectatic or cavitary dis...
Source: Current Respiratory Care Reports - October 9, 2014 Category: Respiratory Medicine Source Type: research
Gastroesophageal reflux disease and the lung transplant recipient
Abstract
Lung transplantation is today a valid treatment for end-stage lung disorders, although long-term survival is still limited by chronic lung allograft dysfunction (CLAD). Repeat evidence has indicated gastroesophageal reflux and consequent retrograde chronic and silent microaspiration as a non-alloimmunogenic inflammatory risk factor for CLAD and/or bronchiolitis obliterans syndrome (BOS). Unfortunately, to date a gold standard methodology for detecting penetrance of refluxed duodenogastric secretions into the lung is lacking, and a definitive marker of retrograde microaspiration secondary to gastr...
Source: Current Respiratory Care Reports - October 2, 2014 Category: Respiratory Medicine Source Type: research
Fibrotic hypersensitivity pneumonitis
Abstract
Fibrotic hypersensitivity pneumonitis (FHP) is a specific form of HP defined by chest imaging evidence or pathologic evidence of fibrosis or scarring. Fibrotic HP appears to be irreversible, is often progressive and frequently indistinguishable from other forms of chronic fibrosing interstitial lung diseases (ILD), in particular idiopathic pulmonary fibrosis (IPF). Accurate diagnosis is a challenge given the diverse and often nonspecific clinicoradiologic patterns, heterogenous clinical course, and a frequent lack of a readily recognizable temporal relationship between exposure to an inciting ant...
Source: Current Respiratory Care Reports - September 26, 2014 Category: Respiratory Medicine Source Type: research
Management of chronic rhinosinusitis
Abstract
Chronic rhinosinusitis (CRS) is a prevalent inflammatory disorder of the paranasal mucosa, which encompasses a complex and heterogeneous disease population with variable pathophysiologic, host, and environmental etiologies. Due to this variability and an evolving understanding of its underlying etiology, successful medical and surgical management cannot be standardized and remains challenging. Medical management remains the first line strategy for this chronic condition with no known cure. Surgical therapy remains an important adjunct intervention when medical therapy fails to control the disease...
Source: Current Respiratory Care Reports - September 26, 2014 Category: Respiratory Medicine Source Type: research
Electronic nicotine delivery systems for smoking cessation: where are we?
Abstract
Electronic cigarettes (e-cigarettes) have surged in popularity since their introduction in 2007. Sales of e-cigarettes and related products in the US were expected to exceed $1B in 2013. With the popularity of the electronic cigarette on the rise, physicians are sure to get questions from patients about the safety of e-cigarettes and their effectiveness as tools for smoking cessation or reduction. Most users of the electronic cigarette are so-called dual users—current cigarette smokers who also use e-cigarettes. The appeal of these devices is largely based on a perception that they are not as h...
Source: Current Respiratory Care Reports - September 18, 2014 Category: Respiratory Medicine Source Type: research
Pulmonary fungal infections- recent updates
Abstract
The field of pulmonary fungal infections is constantly evolving. The at-risk population continues to increase, and the endemic areas for the dimorphic fungi are expanding with new outbreaks reported across the world. Novel diagnostic methods are being developed and existing methods improved and refined. If started in a timely fashion, currently available antifungal agents are fairly effective. In this review we highlight the recent updates in fungal pneumonias focusing on epidemiology, diagnosis, and treatment. (Source: Current Respiratory Care Reports)
Source: Current Respiratory Care Reports - September 14, 2014 Category: Respiratory Medicine Source Type: research
Primary mediastinal B-cell lymphoma
Abstract
Primary mediastinal B-cell lymphoma is an established subtype of non-Hodgkin Lymphoma with distinguishable histopathological and clinical features. It characteristically presents with a bulky mediastinal mass and in a younger, predominantly female population. Advanced age, high LDH levels, and poor performance status are associated with poorer prognosis. Endobronchial ultrasound-guided transbronchial needle aspiration may be a valuable tool for establishing the diagnosis. At a molecular level, it has overlapping traits with nodular sclerosis classical Hodgkin Lymphoma. There is a variety of treat...
Source: Current Respiratory Care Reports - September 3, 2014 Category: Respiratory Medicine Source Type: research
Update to the guidelines for selection of lung-transplant candidates
This article will review the most recent literature on lung transplant candidate selection to provide an updated framework for optimum allocation of this limited resource. (Source: Current Respiratory Care Reports)
Source: Current Respiratory Care Reports - September 1, 2014 Category: Respiratory Medicine Source Type: research
