Home, Hospice, or Hospital: Where Are Our Patients With Chronic Lung Disease Dying?
Synopsis: This cross-sectional study examined the differences in place of death among patients with chronic lung disease living in the United States from 2003 to 2017. Overall, there was a shift toward home and hospice deaths and away from hospital or nursing facility deaths. However, important differences in race, education, and socioeconomic status indicate the pressing need for further research into how to best care for all patients with chronic lung disease at the end of their lives. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - November 1, 2020 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Is a Trial of Observation Safer Than Intervention With Spontaneous Pneumothorax?
Synopsis: Modest evidence that a conservative approach to the treatment of primary spontaneous pneumothorax is noninferior to intervention. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - November 1, 2020 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Bronchoscopy in the COVID-19 Era
Bronchoscopy is an aerosol-generating procedure with important diagnostic and therapeutic indications. However, in the era of the coronavirus disease 2019 (COVID-19) pandemic, airway procedures can put health care providers at an increased risk of exposure and transmission of COVID-19. We have reviewed and summarized guidelines from various societies of respiratory medicine to stratify the indications for bronchoscopy and optimize preprocedural, procedural, and postprocedural preparation. Appropriate measures can help decrease exposure to health care workers when performing this aerosol-generating procedure. (Source: Clini...
Source: Clinical Pulmonary Medicine - November 1, 2020 Category: Respiratory Medicine Tags: Clinical Myths & Evidence-Based Medicine Source Type: research
The Diagnosis of Hypersensitivity Pneumonitis and the Role of Lung Biopsy
Hypersensitivity pneumonitis (HP) refers to a collective noun of diffuse lung diseases encompassing some degree of bronchiolar and interstitial granulomatous inflammation that results from persistent inhalation exposure and consequent immune sensitization to a large potential diversity of (predominantly) organic antigens in predisposed individuals. In suspected cases of HP, forceps transbronchial lung biopsy (TBLB) has been traditionally performed on a case-by-case basis along with bronchoalveolar lavage. This option has been subject to some debate and its use is more restrained in the presence of a chronic fibrotic form o...
Source: Clinical Pulmonary Medicine - November 1, 2020 Category: Respiratory Medicine Tags: Interstitial, Inflammatory & Occupational Lung Disease Source Type: research
Immune-related Pulmonary Toxicity From Cancer Immunotherapy: A Systematic Approach
Immune checkpoint inhibitors (ICIs) are one of the major advances in cancer treatment. ICIs have shown significant benefit in treating several types of cancer. Currently there are 6 ICIs available in the United States and multiple ICIs in the pipeline. Immune checkpoint signaling leads to immune tolerance of cancer cells through downregulation of T-cell activation. The reversal in tumor-tolerance and self-tolerance effected by ICIs likely drives both T-cell–mediated toxicity and immune-related adverse effects (irAEs); however, the exact mechanism remains not completely understood. Pulmonary irAEs are among the most feare...
Source: Clinical Pulmonary Medicine - November 1, 2020 Category: Respiratory Medicine Tags: Interstitial, Inflammatory & Occupational Lung Disease Source Type: research
Excessive Dynamic Airway Collapse: A COPD/Asthma Mimic or a Treatment-emergent Consequence of Inhaled Corticosteroid Therapy: Case Series and Brief Literature Review
In this report, we describe 6 adult patients presenting with chronic cough with a background diagnosis of either COPD or asthma on ICS, who were noted to have EDAC. We also made an attempt to briefly review the earlier published reports on EDAC. Our review suggested that EDAC is prevalent among patients with previous diagnosis of COPD/asthma and with ICS use. Female sex, older age, higher body mass index, and presence of gastroesophageal reflux disease (GORD), and chronic upper respiratory tract infections (URTI) may be a risk factor for EDAC. Chronic barking cough and shortness of breath are the common clinical presentati...
Source: Clinical Pulmonary Medicine - November 1, 2020 Category: Respiratory Medicine Tags: Obstructive Airways Disease Source Type: research
The Complex Relationship Between Poor Sleep Quality and Chronic Obstructive Pulmonary Disease
Sleep-related symptoms are prevalent among patients with chronic obstructive pulmonary disease (COPD). The disease process often manifests with nocturnal respiratory symptoms. Long-acting antimuscarinic medications improve nocturnal COPD symptoms, though their effect on sleep quality requires further investigation. Those with COPD often suffer from comorbidities that negatively impact sleep, including obstructive sleep apnea (OSA) and mood disorders such as anxiety and depression. Sleep quality is also predictive of COPD exacerbations. Patients with concurrent COPD and OSA suffer from overlap syndrome (OVS), characterized ...
Source: Clinical Pulmonary Medicine - November 1, 2020 Category: Respiratory Medicine Tags: Obstructive Airways Disease Source Type: research
Corticosteroids for COVID-19-Associated ARDS
Systemic corticosteroids have emerged as a possible therapy to mitigate lung injury in severe COVID-19 infection. Here, we provide historical context for corticosteroid administration in acute respiratory failure due to viral infection and review existing data for the use of systemic corticosteroids for SARS-CoV-2 infection. The results of these limited data consistently suggest a mortality benefit for patients with COVID-19-associated acute respiratory distress syndrome with no existing evidence to suggest harm. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - November 1, 2020 Category: Respiratory Medicine Tags: Critical Care/Respiratory Care Source Type: research
Vaping-associated Lung Injury Successfully Treated With Pulse Dose Corticosteroids
We report 3 previously healthy male patients, who presented with acute respiratory failure with a recent history of electronic cigarette use, ultimately diagnosed with lipoid pneumonia. All 3 patients received intravenous high-dose, pulse corticosteroids for short duration with dramatic improvement. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - November 1, 2020 Category: Respiratory Medicine Tags: Critical Care/Respiratory Care Source Type: research
How Does the Efficacy and Safety of Triple Inhaled Therapy at 2 Glucocorticoid Doses Compare With 2 Dual Therapies in Moderate-to-Very-Severe COPD?
Synopsis: This 52-week, phase 3, randomized, double-blind, parallel-group trial compared the efficacy and safety of twice-daily inhaled triple therapy with budesonide at 2 different doses (160 and 320-μg) plus a LAMA (18-μg of glycopyrrolate) and a LABA (9.6-μg of formoterol) in comparison with either glycopyrrolate-formoterol (18 and 9.6-μg) or budesonide-formoterol (320 and 9.6-μg) in patients with moderate-to-very-severe COPD with at least 1 exacerbation in the past year. Similar to previous trials, there was a significant reduction in the annual rate of moderate-to-severe exacerbations and improved patient-reporte...
Source: Clinical Pulmonary Medicine - September 1, 2020 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Dexamethasone in Acute Respiratory Distress Syndrome
Synopsis: In patients with moderate-to-severe acute respiratory distress syndrome (ARDS), defined as an arterial oxygen partial pressure/ fractional inspired oxygen (PaO2/FiO2) of 200 mm Hg or less with a positive end-expiratory pressure (PEEP) of 10 cm H2O or greater and FiO2>0.5, administration of dexamethasone within 24 hours of ARDS onset led to more ventilator-free days, and a reduction of all-cause mortality with no difference in adverse events. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - September 1, 2020 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Clinical and Radiologic Improvement Following Tocilizumab Administration in Patients With SARS-CoV-2
We report on 2 severely ill patients with COVID-19 treated with tocilizumab within 7 to 10 days of onset of symptoms. Tocilizumab markedly improved their clinical condition and was associated with regression of abnormalities on chest computed tomography within 1 week of tocilizumab administration. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - September 1, 2020 Category: Respiratory Medicine Tags: Images in Pulmonary Medicine Source Type: research
Laboratory Diagnosis of COVID-19
SARS-CoV-2 in bats was transmitted to humans by a peridomestic mammal in China and it was transmitted from humans to humans very quickly through coughing and sneezing and is spread all over the world and created coronavirus disease 2019. The disease causes a variety of symptoms in patients and it has killed a significant number of people around the world, especially people with underlying diseases such as heart disease, diabetes, and high blood pressure. Early diagnosis of patients is very important to prevent the transmission of the disease from humans to humans and the spread of the virus. The virus causes abnormal compu...
Source: Clinical Pulmonary Medicine - September 1, 2020 Category: Respiratory Medicine Tags: Clinical Practice Management Source Type: research
Immunotherapy-induced Pneumonitis: A Review of Diagnostic Workup and Treatment Guidelines
Lung cancer remains the leading cause of cancer-related deaths worldwide; however, new developments in treatment, specifically immune checkpoint inhibitors, have demonstrated improved progression-free survival. Unfortunately, these medications are not without side effects, including the potentially life-threatening side effect of immune-related pneumonitis. There are a paucity of data with regard to risk factors and diagnostic criteria, leading to a complicated diagnostic dilemma for providers. In addition, guidelines as regards treatment and reinitiation of therapy are sparse at best. Both these factors lead to significan...
Source: Clinical Pulmonary Medicine - September 1, 2020 Category: Respiratory Medicine Tags: Topics in Pulmonary Medicine Source Type: research
“Popcorn” Cavitary Pneumonia: A Case Report
Upper lobe cavitation carries a broad differential. No review, to our knowledge, includes foreign body in the differential diagnosis. Similarly, reviews of foreign body aspiration do not report lung cavitation. Herein, we report a case of an alert 58-year-old man who presented with sepsis secondary to presumed right upper lobe pneumonia. Computed tomography of the chest was significant for multiple loculated cavitary lesions. Subsequent bronchoscopy revealed a single kernel of popcorn impacted in the bronchus. Our case report highlights the importance of recognizing atypical presentations of foreign body aspiration. (Sourc...
Source: Clinical Pulmonary Medicine - September 1, 2020 Category: Respiratory Medicine Tags: Respiratory Infections/Images Source Type: research
