Managing pleural malignancy
Pleural malignancy is a growing problem, with malignant pleural effusions (MPEs) affecting 70 per 100,000 people every year. Around 15% of all cancer patients are diagnosed with pleural malignancy during their cancer journey, and they are treated by general and respiratory physicians alike. MPEs usually indicate advanced or aggressive disease, with median survival typically 6 –12 months. Symptoms can be debilitating, so effusion management and symptom control form key aspects of care. Management options for MPE have grown in recent years, and important differences in the benefits and disadvantages of the various methods...
Source: Medicine - October 31, 2023 Category: Internal Medicine Authors: Geraldine A. Lynch, Anna Bibby, Nick A. Maskell Tags: Pulmonary oncology Source Type: research
Idiopathic pulmonary fibrosis and progressive fibrotic interstitial lung disease
Interstitial lung diseases (ILDs) represent a spectrum of disorders affecting the lung parenchyma. The most common of the idiopathic interstitial pneumonias is idiopathic pulmonary fibrosis (IPF), characterized by progressive lung fibrosis, lung function decline, symptom burden and early mortality. The precise aetiology of IPF remains unknown and there are currently no curative treatment options; management strategies focus on symptom control and slowing disease progression with antifibrotic medication. (Source: Medicine)
Source: Medicine - October 28, 2023 Category: Internal Medicine Authors: Philip Evans, Elen Rowlands, Ben Hope-Gill Tags: Interstitial lung disease and systemic disease presenting in the lung Source Type: research
Occupational interstitial lung disease
Interstitial lung diseases (ILDs) are a diverse group of lung parenchymal diseases. They cover a spectrum of inflammatory to fibrotic pathologies. Many ILDs are labelled idiopathic, meaning there is no recognized cause, but many can be triggered by environmental and occupational exposures. Occupational ILD can present as many different ILD subtypes, including hypersensitivity pneumonitis, granulomatous disease (e.g. chronic beryllium disease), pneumoconiosis (silicosis) and usual interstitial pneumonia (typically asbestosis). (Source: Medicine)
Source: Medicine - October 28, 2023 Category: Internal Medicine Authors: Christopher C. Huntley, Kimberley Nettleton, Vicky C. Moore, Gareth I. Walters Tags: Interstitial lung disease and systemic disease presenting in the lung Source Type: research
Pneumothorax
A pneumothorax is defined as a collection of air between the lung and the chest wall. It can occur spontaneously without lung disease (primary spontaneous pneumothorax) or with underlying lung disease (secondary spontaneous pneumothorax). Trauma, iatrogenic complications of medical procedures and catamenial pneumothorax are other recognized causes. Breathlessness and chest pain are common symptoms. Chest X-ray is the most important investigation to detect and monitor a pneumothorax. Computed tomography of the chest has been widely used as it provides information about the underlying cause and helps to guide intervention. (Source: Medicine)
Source: Medicine - October 28, 2023 Category: Internal Medicine Authors: Beenish Iqbal, Rob Hallifax Tags: Other disorders of the lung Source Type: research
Lung cancer: investigation and staging
The aim of achieving an accurate diagnosis and staging of lung cancer is to ensure that patients can be offered the most appropriate treatment. Investigations should yield the required level of diagnostic and staging information with the least risk and discomfort for the patient. It is vital that this is in line with the patient's wishes and appropriate to their fitness as well as the potential treatment. Contrast-enhanced computed tomography (CT) of the lower neck, chest, liver and adrenals should be available for most patients at the first clinical assessment. (Source: Medicine)
Source: Medicine - October 28, 2023 Category: Internal Medicine Authors: David R. Baldwin, Akari Thu Tags: Pulmonary oncology Source Type: research
Pulmonary vascular disease: pulmonary thromboembolism and pulmonary hypertension
The alveolar –capillary barrier, comprising capillary endothelium, extracellular matrix and alveolar epithelium, is a thin membrane that provides a large surface area for diffusive gas exchange. In human health, the pulmonary circulation is completely separate from the systemic circulation, which allows the ma intenance of a high-flow, low-pressure circuit to ensure optimal gas exchange even with increasing physiological demands. Increases in pressure within this circulation either acutely, for example secondary to pulmonary embolism, or over time secondary to vascular remodelling, can detrimentally affec t ventilatory e...
Source: Medicine - October 28, 2023 Category: Internal Medicine Authors: Gulam Haji, Tobin Joseph, Rachel Davies Tags: Pulmonary vascular disease Source Type: research
Connective tissue diseases and the lung
Connective tissue diseases (CTDs) include a spectrum of multisystem disorders. Interstitial lung disease (ILD) is an important cause of considerable morbidity and mortality in CTD patients. Although the various CTDs associated with ILD are often considered together because of their shared autoimmune nature, there are substantial differences in clinical presentations and ILD manifestations that are important to consider with regard to management. Here, we summarize each of these major CTD subtypes, highlight how CTD can lead to respiratory manifestations ranging from mild to life-threatening ILD, and discuss the rationale f...
Source: Medicine - October 28, 2023 Category: Internal Medicine Authors: Andrew Achaiah, Rachel Hoyles, Peter Saunders Tags: Interstitial lung disease and systemic disease presenting in the lung Source Type: research
Self-assessment/CPD answers
Question 1 (Source: Medicine)
Source: Medicine - October 28, 2023 Category: Internal Medicine Tags: Self-assessment/cpd answers Source Type: research
Contents
(Source: Medicine)
Source: Medicine - October 22, 2023 Category: Internal Medicine Source Type: research
Editorial Board
(Source: Medicine)
Source: Medicine - October 22, 2023 Category: Internal Medicine Source Type: research
Management of COVID-19 infection
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for coronavirus disease (COVID-19), is estimated to have infected over two-thirds of the world's population and resulted in>6.8 million deaths (as of March 2023). Although multisystem manifestations can occur, COVID-19 is predominantly a respiratory pathogen, and pneumonia is the major cause of morbidity and mortality in hospitalized patients. Management remains largely supportive although, since the start of the pandemic, thousands of research studies, including platform trials RECOVERY and REMAP-CAP, have led to more tailored treatments t...
Source: Medicine - October 4, 2023 Category: Internal Medicine Authors: Huiyi Esther Law, Emily Fraser Tags: Pulmonary infection Source Type: research
Opportunistic bacterial, viral and fungal infections of the lung
Respiratory opportunistic infections are a major cause of morbidity and mortality in severely immunocompromised patients, such as those treated with biological therapies, chemotherapy and solid organ or stem cell transplants, and those with haematological malignancy, aplastic anaemia or HIV infection. The type and degree of immune defect dictates the profile of potential opportunistic pathogens; T-cell-mediated defects increase the risk of viral (cytomegalovirus, respiratory viruses) and Pneumocystis jirovecii infections, whereas neutrophil defects are associated with bacterial pneumonia and invasive aspergillosis. (Source: Medicine)
Source: Medicine - October 3, 2023 Category: Internal Medicine Authors: Katharine M. Pates, Jimstan N. Periselneris, Jeremy S. Brown Tags: Pulmonary infection Source Type: research
Obstructive sleep apnoea
occurs during sleep when there is repeated pharyngeal collapse that obstructs the airway and causes repeated awakenings from sleep. Sufferers complain of unrefreshing sleep and daytime somnolence. Bed partners usually report snoring with apnoeic attacks. Problems with tasks requiring concentration, such as driving, are common. In severe obstructive sleep apnoea the rate of road traffic accidents secondary to sleepiness is increased. A sleep study incorporating respiratory assessment is required to confirm the diagnosis and severity before the decision is made to initiate continuous positive airway pressure treatment. (Source: Medicine)
Source: Medicine - October 3, 2023 Category: Internal Medicine Authors: Irfan Zaki, Su Latt Phyu, Chris Turnbull Tags: Sleep medicine and lung failure Source Type: research
Pleural infection
in adults remains a challenging condition to treat with poor outcomes that have persisted over several decades. Research efforts in recent years have significantly advanced our understanding of the aetiopathogenesis and the underlying biology of the infected pleural space. Geographical location and infection setting provide an insight of causative microorganism. Poor pleural fluid culture yields frequently necessitate prolonged courses of broad-spectrum antibiotics. With increased research and accessibility to molecular-based techniques, yields are expected to improve. (Source: Medicine)
Source: Medicine - October 3, 2023 Category: Internal Medicine Authors: Alguili Elsheikh, Najib M. Rahman, Eihab O. Bedawi Tags: Pulmonary infection Source Type: research
Management of acute respiratory failure
Acute respiratory failure is the most common indication for admission to critical care. Appropriate management requires the early recognition and identification of precipitating factors, understanding of the pathophysiology and a systematic approach to assessing disease severity. Finally, if necessary, respiratory support can be non-invasive or invasive mechanical ventilation, and adjunctive therapies, including the timely use of extracorporeal respiratory support. (Source: Medicine)
Source: Medicine - October 3, 2023 Category: Internal Medicine Authors: Francesco Vasques, Michael Slattery, Shelley Srivastava, Luigi Camporota Tags: Sleep medicine and lung failure Source Type: research
