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 9, 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 6, 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 3, 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 2, 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 1, 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 27, 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 bronchiectasis, ...
Source: Current Respiratory Care Reports - November 25, 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 25, 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-month ...
Source: Current Respiratory Care Reports - November 25, 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 25, 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 29, 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 21, 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 16, 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 15, 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 15, 2019 Category: Respiratory Medicine Source Type: research
