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 10, 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 23, 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 Findin...
Source: Current Respiratory Care Reports - May 1, 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 25, 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 10, 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 12, 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 managing com...
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 suggest...
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 also...
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
