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Diagnostic Approach to Interstitial Lung Diseases Associated with Connective Tissue Diseases
Semin Respir Crit Care Med DOI: 10.1055/s-0044-1785674Interstitial lung disorders are a group of respiratory diseases characterized by interstitial compartment infiltration, varying degrees of infiltration, and fibrosis, with or without small airway involvement. Although some are idiopathic (e.g., idiopathic pulmonary fibrosis, idiopathic interstitial pneumonias, and sarcoidosis), the great majority have an underlying etiology, such as systemic autoimmune rheumatic disease (SARD, also called Connective Tissue Diseases or CTD), inhalational exposure to organic matter, medications, and rarely, genetic disorders. This review ...
Source: Seminars in Respiratory and Critical Care Medicine - April 17, 2024 Category: Respiratory Medicine Authors: Zamora, Ana C. Wesselius, Lewis J. Gotway, Michael B. Tazelaar, Henry D. Diaz-Arumir, Alejandro Nagaraja, Vivek Tags: Review Article Source Type: research

The Oral –Lung Microbiome Axis in Connective Tissue Disease-Related Interstitial Lung Disease
Semin Respir Crit Care Med DOI: 10.1055/s-0044-1785673Connective tissue disease-related interstitial lung disease (CTD-ILD) is a frequent and serious complication of CTD, leading to high morbidity and mortality. Unfortunately, its pathogenesis remains poorly understood; however, one intriguing contributing factor may be the microbiome of the mouth and lungs. The oral microbiome, which is a major source of the lung microbiome through recurrent microaspiration, is altered in ILD patients. Moreover, in recent years, several lines of evidence suggest that changes in the oral and lung microbiota modulate the pulmonary immune re...
Source: Seminars in Respiratory and Critical Care Medicine - April 16, 2024 Category: Respiratory Medicine Authors: Bongers, Kale S. Massett, Angeline O'Dwyer, David N. Tags: Review Article Source Type: research

Pulmonary Manifestations of Sj ögren's Disease
Semin Respir Crit Care Med DOI: 10.1055/s-0044-1785675Sjögren's disease (SjD) is a chronic, progressive autoimmune condition of exocrine and extraglandular tissues. It can present with isolated disease characterized by lymphocytic infiltration of salivary or lacrimal glands, but in approximately one-third of the patients, lymphocytic infiltration extends beyond exocrine glands to involve extraglandular organs such as the lungs. Pulmonary complications have been reported to occur between 9 and 27% of patients with SjD across studies. Respiratory manifestations occur on a spectrum of severity and include airways disease, in...
Source: Seminars in Respiratory and Critical Care Medicine - April 15, 2024 Category: Respiratory Medicine Authors: Byrne, Louise McCarthy, Cormac Fabre, Aurelie Gupta, Nishant Tags: Review Article Source Type: research

Severe Community-Acquired Pneumonia: Noninvasive Mechanical Ventilation, Intubation, and HFNT
The objective of all the supporting measures for ARF is to gain time for the antimicrobial treatment to cure the pneumonia. There is uncertainty regarding which patients with severe CAP are most likely to benefit from each noninvasive support strategy. HFNT may be the first-line approach in the majority of patients. While NIV may be relatively contraindicated in patients with excessive secretions, facial hair/structure resulting in air leaks or poor compliance, NIV may be preferable in those with increased work of breathing, respiratory muscle fatigue, and congestive heart failure, in which the positive pressure of NIV may...
Source: Seminars in Respiratory and Critical Care Medicine - April 11, 2024 Category: Respiratory Medicine Authors: Ferrer, Miquel Pascale, Gennaro De Tanzarella, Eloisa S. Antonelli, Massimo Tags: Review Article Source Type: research

Severe Community-Acquired Pneumonia
Semin Respir Crit Care Med 2024; 45: 141-142 DOI: 10.1055/s-0044-1780515 Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of contents  |  Full text (Source: Seminars in Respiratory and Critical Care Medicine)
Source: Seminars in Respiratory and Critical Care Medicine - April 11, 2024 Category: Respiratory Medicine Authors: Martin-Loeches, Ignacio Torres, Antoni Tags: Preface Source Type: research

Pleural Diseases in Connective Tissue Diseases
Semin Respir Crit Care Med DOI: 10.1055/s-0044-1782612Connective tissue diseases (CTD) are heterogeneous, immune-mediated inflammatory disorders often presenting with multiorgan involvement. With the advent of high-resolution computed tomography, CTD-related pleuritis—pleural thickening and effusion—is now increasingly recognized early in the disease trajectory. The natural history of CTD-related pleural effusions varies from spontaneous resolution to progressive fibrothorax with ventilatory impairment. Treatment of the underlying CTD is necessary to manage the pleural disease. Depending on the degree of symptom burden...
Source: Seminars in Respiratory and Critical Care Medicine - March 28, 2024 Category: Respiratory Medicine Authors: Guo, Hui Iqbal, Beenish Rahman, Najib M. Tags: Review Article Source Type: research

Approach to Pulmonary Nodules in Connective Tissue Disease
Semin Respir Crit Care Med DOI: 10.1055/s-0044-1782656The assessment of pulmonary nodules is a common and often challenging clinical scenario. This evaluation becomes even more complex in patients with connective tissue diseases (CTDs), as a range of disease-related factors must also be taken into account. These diseases are characterized by immune-mediated chronic inflammation, leading to tissue damage, collagen deposition, and subsequent organ dysfunction. A thorough examination of nodule features in these patients is required, incorporating anatomic and functional information, along with patient demographics, clinical f...
Source: Seminars in Respiratory and Critical Care Medicine - March 28, 2024 Category: Respiratory Medicine Authors: Gaffney, Brian Murphy, David J. Tags: Review Article Source Type: research

Systemic Lupus Erythematosus-related Lung Disease
Semin Respir Crit Care Med DOI: 10.1055/s-0044-1782653Systemic Lupus Erythematosus (SLE) is a multifaceted, multisystem autoimmune disorder with diverse clinical expressions. While prevalence reports vary widely, pulmonary involvement accounts for significant morbidity and mortality in SLE. This comprehensive review explores the spectrum of pulmonary disease in SLE, including upper airway manifestations (e.g., laryngeal affection), lower airway conditions (e.g., bronchitis, bronchiolitis, bronchiectasis), parenchymal diseases (e.g., interstitial lung disease, acute lupus pneumonitis, diffuse alveolar hemorrhage), pleural d...
Source: Seminars in Respiratory and Critical Care Medicine - March 28, 2024 Category: Respiratory Medicine Authors: Bendstrup, Elisabeth Lynn, Evelyn Troldborg, Anne Tags: Review Article Source Type: research

Pulmonary Manifestations of Connective Tissue Diseases
Semin Respir Crit Care Med DOI: 10.1055/s-0044-1782607Systemic sclerosis is a multisystem connective tissue disease that is associated with substantial morbidity and mortality. Visceral organ involvement is common in patients with systemic sclerosis and occurs independently of skin manifestations. Pulmonary hypertension (PH) is an important and prevalent complication of systemic sclerosis. The clinical classification of PH cohorts conditions with similar pathophysiological mechanisms into one of five groups. While patients with systemic sclerosis can manifest with a spectrum of pulmonary vascular disease, notable clinical ...
Source: Seminars in Respiratory and Critical Care Medicine - March 26, 2024 Category: Respiratory Medicine Authors: Cullivan, Sarah Cronin, Eleanor Gaine, Sean Tags: Review Article Source Type: research

Pulmonary Hypertension in Connective Tissue Diseases Other than Systemic Sclerosis
Semin Respir Crit Care Med DOI: 10.1055/s-0044-1782217Pulmonary hypertension (PH) is a known complication of certain connective tissue diseases (CTDs), with systemic sclerosis (SSc) being the most common in the Western world. However, PH in association with non-SSc CTD such as systemic lupus erythematous, mixed connective tissue disease, and primary Sjögren's syndrome constitutes a distinct subset of patients with inherently different epidemiologic profiles, pathophysiologic mechanisms, clinical features, therapeutic options, and prognostic implications. The purpose of this review is to inform a practical approach for cli...
Source: Seminars in Respiratory and Critical Care Medicine - March 18, 2024 Category: Respiratory Medicine Authors: Budhram, Brandon Weatherald, Jason Humbert, Marc Tags: Review Article Source Type: research

Overview of Rheumatoid Arthritis-Associated Interstitial Lung Disease and Its Treatment
Semin Respir Crit Care Med DOI: 10.1055/s-0044-1782218Interstitial lung disease (ILD) is a common pulmonary complication of rheumatoid arthritis (RA), causing significant morbidity and mortality. Optimal treatment for RA-ILD is not yet well defined. Reliable prognostic indicators are largely byproducts of prior ILD progression, including low or decreasing forced vital capacity and extensive or worsening fibrosis on imaging. In the absence of validated tools to predict treatment response, decisions about whether to initiate or augment treatment are instead based on clinical judgment. In general, treatment should be initiate...
Source: Seminars in Respiratory and Critical Care Medicine - March 14, 2024 Category: Respiratory Medicine Authors: Pugashetti, Janelle Vu Lee, Joyce S. Tags: Review Article Source Type: research

New Guidelines for Severe Community-acquired Pneumonia
Semin Respir Crit Care Med DOI: 10.1055/s-0043-1777797In 2023, the new European guidelines on severe community-acquired pneumonia, providing clinical practice recommendations for the management of this life-threatening infection, characterized by a high burden of mortality, morbidity, and costs for the society. This review article aims to summarize the principal evidence related to eight different questions covered in the guidelines, by also highlighting the future perspectives for research activity. [...] Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Ta...
Source: Seminars in Respiratory and Critical Care Medicine - March 1, 2024 Category: Respiratory Medicine Authors: Calabretta, Davide Mart ìn-Loeches, Ignacio Torres, Antoni Tags: Review Article Source Type: research

Long-Term Outcomes in Severe Community-Acquired Pneumonia
Semin Respir Crit Care Med DOI: 10.1055/s-0044-1781426Community-acquired pneumonia (CAP) is globally one of the major causes of hospitalization and mortality. Severe CAP (sCAP) presents great challenges and need a comprehensive understanding of its long-term outcomes. Cardiovascular events and neurological impairment, due to persistent inflammation and hypoxemia, contribute to long-term outcomes in CAP, including mortality. Very few data are available in the specific population of sCAP. Multiple studies have reported variable 1-year mortality rates for patients with CAP up to 40.7%, with a clear influence by age, comorbidi...
Source: Seminars in Respiratory and Critical Care Medicine - February 23, 2024 Category: Respiratory Medicine Authors: Carella, Francesco Aliberti, Stefano Stainer, Anna Voza, Antonio Blasi, Francesco Tags: Review Article Source Type: research

Definition, Epidemiology, and Pathogenesis of Severe Community-Acquired Pneumonia
Semin Respir Crit Care Med DOI: 10.1055/s-0044-1779016The clinical presentation of community-acquired pneumonia (CAP) can vary widely among patients. While many individuals with mild symptoms can be managed as outpatients with excellent outcomes, there is a distinct subgroup of patients who present with severe CAP. In these cases, the mortality rate can reach approximately 25% within 30 days and even up to 50% within a year. It is crucial to focus attention on these patients who are at higher risk.Among the various definitions of severe CAP found in the literature, one commonly used criterion is the requirement for admissi...
Source: Seminars in Respiratory and Critical Care Medicine - February 8, 2024 Category: Respiratory Medicine Authors: Cavallazzi, Rodrigo Ramirez, Julio A. Tags: Review Article Source Type: research

Risk of Multidrug-Resistant Pathogens in Severe Community-Acquired Pneumonia
Semin Respir Crit Care Med DOI: 10.1055/s-0043-1778138Severe community-acquired pneumonia (SCAP) is difficult to treat when caused by difficult-to-treat (DTR) pathogens because of limited treatment options and poorer clinical outcomes. Over time, several predictive scoring systems based on risk factors for infection with multidrug resistant pathogens have been developed. We reviewed the available tools for identifying DTR pathogens as the cause of SCAP, both predictive scoring systems and rapid diagnostic methods, to develop management strategies aimed at early identification of DTR pathogens, reducing broad-spectrum antib...
Source: Seminars in Respiratory and Critical Care Medicine - February 1, 2024 Category: Respiratory Medicine Authors: Campa ña-Duel, E. Camprub í-Rimblas, M. Areny-Balaguer ó, A. Quero, Sara Artigas, A. Ceccato, A. Tags: Review Article Source Type: research