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Current Opinion in Pulmonary Medicine

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https://read.qxmd.com/read/30762612/genetic-profiling-for-disease-stratification-in-chronic-obstructive-pulmonary-disease-and-asthma
#1
Senani N H Rathnayake, Maarten Van den Berge, Alen Faiz
PURPOSE OF REVIEW: In asthma and chronic obstructive pulmonary disease (COPD), the movement towards genetic profiling with a push towards 'personalized medicine' has been hindered by complex environment--gene interactions and lack of tools to identify clear causal genetic traits. In this review, we will discuss the need for genetic profiling in asthma and COPD, what methods are currently used in the clinics and the recent finding using new sequencing methods. RECENT FINDINGS: Over the past 10-15 years, genome-wide association studies analysis of common variants has provide little in the way of new genetic profiling markers for asthma and COPD...
February 11, 2019: Current Opinion in Pulmonary Medicine
https://read.qxmd.com/read/30730312/transmission-and-prevention-of-acute-viral-respiratory-tract-infections-in-hospitals
#2
Peter Wilson, Alimuddin Zumla
PURPOSE OF REVIEW: Transmission of acute respiratory tract viral infections in healthcare environments is a major problem worldwide. We review recent literature of viruses imported to hospitals from the local community and from abroad, their modes of transmission and measures required to reduce and contain them. RECENT FINDINGS: Common causes of outbreaks include influenza viruses, respiratory syncytial virus, adenovirus, and coronaviruses. Major lethal outbreaks of viral respiratory infections in hospitals have been caused by coronaviruses imported from abroad by travelers...
February 5, 2019: Current Opinion in Pulmonary Medicine
https://read.qxmd.com/read/30730311/computed-tomography-scan-contribution-to-the-diagnosis-of-community-acquired-pneumonia
#3
Nicolas Garin, Christophe Marti, Max Scheffler, Jérôme Stirnemann, Virginie Prendki
PURPOSE OF REVIEW: Pneumonia is a frequent disease mainly affecting older and multimorbid patients. Symptoms and signs lack sensitivity and specificity, and chest X-ray has poor accuracy. Hence, an initial diagnosis of pneumonia has limited predictive value for the presence of pneumonia. Overdiagnosis of pneumonia leads to inappropriate antibiotic use and may delay the appropriate management of mimicking diseases. Alternative imaging strategies including computed tomography (CT)-scan or lung ultrasonography may improve the diagnosis of pneumonia...
February 5, 2019: Current Opinion in Pulmonary Medicine
https://read.qxmd.com/read/30608257/reflections-on-chronic-obstructive-pulmonary-disease-and-related-topics-and-respiratory-health-consequences-of-wildfires
#4
Manish Joshi, Basil Varkey
No abstract text is available yet for this article.
January 2, 2019: Current Opinion in Pulmonary Medicine
https://read.qxmd.com/read/30601179/comparing-current-us-and-european-guidelines-for-nosocomial-pneumonia
#5
Daire N Kelly, Ignacio Martin-Loeches
PURPOSE OF REVIEW: In the last 2 years, two major guidelines for the management of nosocomial pneumonia have been published: The International European Respiratory Society/European Society of Intensive Care Medicine/European Society of Clinical Microbiology and Infectious Diseases/Asociación Latinoamericana de Toráx guidelines for the management of hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) and the American guidelines for management of adults with HAP and VAP; both the guidelines made important clinical recommendations for the management of patients...
December 28, 2018: Current Opinion in Pulmonary Medicine
https://read.qxmd.com/read/30585861/outpatient-management-of-community-acquired-pneumonia
#6
Filipe Froes, João Gonçalves Pereira, Pedro Póvoa
PURPOSE OF REVIEW: Although most patients with community-acquired pneumonia (CAP) are treated as outpatients, the majority of data regarding CAP management is provided by hospitals, either from emergency department or inpatients. This was already noted in the first CAP guidelines, published in 1993, and the challenges regarding the outpatient management of CAP persist nowadays. These include the uncertainty of the initial diagnosis and risk stratification, the empirical choice of antibiotics, the overgrowing of antibiotic resistance bacteria and the relative scarcity of novel antibiotics...
December 24, 2018: Current Opinion in Pulmonary Medicine
https://read.qxmd.com/read/30562188/inhaled-antibiotics-for-the-treatment-of-pneumonia
#7
Matthew P Schreiber, Andrew F Shorr
PURPOSE OF REVIEW: To describe recent developments in trials exploring inhaled antibiotics for treating severe pneumonia. RECENT FINDINGS: Three recent randomized studies investigated the potential role for aerosolized antibiotics for gram-negative pneumonia in ventilated patients. One single center, nonblinded investigation suggested a benefit with inhaled amikacin for resistant gram-negative infections. However, two multicenter, blinded trials found no benefit to adjunctive nebulized amikacin for severe gram-negative pneumonia...
December 17, 2018: Current Opinion in Pulmonary Medicine
https://read.qxmd.com/read/30520743/biomarkers-for-chronic-obstructive-pulmonary-disease-diagnosis-and-progression-insights-disappointments-and-promise
#8
David M Mannino
PURPOSE OF REVIEW: This article reviews the status of biomarkers useful in the diagnosis and progression of chronic obstructive pulmonary disease (COPD). Biomarkers have been the focus of a great deal of COPD-related research in recent years, although useful markers in these specific arenas remain elusive. RECENT FINDINGS: No biomarker other than lung function has been shown to be useful, to date, for the diagnosis of COPD. The best blood-based biomarkers for the progression of COPD may involve combinations of individual markers, such as CC16, fibrinogen and sRAGE...
December 4, 2018: Current Opinion in Pulmonary Medicine
https://read.qxmd.com/read/30507646/inhaled-corticosteroids-and-fractures-in-chronic-obstructive-pulmonary-disease-current-understanding-and-recommendations
#9
Ji-Yong Moon, Don D Sin
PURPOSE OF REVIEW: Inhaled corticosteroid (ICS) is commonly used in the management of patients with chronic obstructive pulmonary disease (COPD) for symptom relief and exacerbation prevention; however, there is a growing concern that ICS increases risk of osteoporosis and fractures in patients with COPD. RECENT FINDINGS: Osteoporosis is a major comorbidity of COPD. There is evidence from large observational studies that use of ICS for prolonged period of time (e...
November 30, 2018: Current Opinion in Pulmonary Medicine
https://read.qxmd.com/read/30640188/bronchoscopic-device-intervention-in-chronic-obstructive-pulmonary-disease
#10
Daniel G Dunlap, Roy Semaan, Craig M Riley, Frank C Sciurba
PURPOSE OF REVIEW: Chronic obstructive pulmonary disease is a heterogeneous syndrome associated with varying degrees of parenchymal emphysema and airway inflammation resulting in decreased expiratory flow, lung hyperinflation, and symptoms leading to decreased exercise tolerance and quality of life. Impairment in lung function and quality of life persists following guideline-based medical therapy, thus surgical and minimally invasive bronchoscopic approaches were developed to address this unmet need...
March 2019: Current Opinion in Pulmonary Medicine
https://read.qxmd.com/read/30640187/noncystic-fibrosis-bronchiectasis-management-opportunities-and-challenges
#11
Emily G Kocurek, Rajani Jagana
PURPOSE OF REVIEW: Noncystic fibrosis bronchiectasis is a challenging disease which carries a heavy healthcare burden and significant mortality and morbidity. This review highlights the challenges in the diagnosis of bronchiectasis and discusses the management strategies and research opportunities in this field. RECENT FINDINGS: The challenges in the management of bronchiectasis appear to be multifactorial, arising from both etiological heterogeneity and disease-specific management...
March 2019: Current Opinion in Pulmonary Medicine
https://read.qxmd.com/read/30608256/assessment-and-treatment-of-acute-toxic-inhalations
#12
Clayton T Cowl
PURPOSE OF REVIEW: Acute toxic inhalation exposures affect thousands of individuals worldwide each year. The acute evaluation of these inhaled exposures is often fraught with difficulty in identifying a specific agent, may involve multiple compounds, and a wide variety of responses are seen depending on the physical properties of the specific toxicant, the length of time of inhalation, and the concentration of the exposure. Recognizing key aspects of the most common acute toxic inhalations is useful in developing a diagnosis and treatment strategy...
March 2019: Current Opinion in Pulmonary Medicine
https://read.qxmd.com/read/30562187/tobacco-smoking-in-china-a-pulmonary-health-crisis
#13
Eric L Flenaugh
PURPOSE OF REVIEW: China's economy has had tremendous growth through the principle of command economy, where profitable private industries become government-owned and managed. The tobacco industry, which generates 10% of the annual governmental income from the country's over 300 million smokers, serves as a prime example. The present review takes an in-depth look at how the success of the government's tobacco industry has caused a pulmonary health crisis for the country with the world's largest population; and in turn, poses a threat to global lung health...
March 2019: Current Opinion in Pulmonary Medicine
https://read.qxmd.com/read/30550505/procalcitonin-and-other-markers-to-guide-antibiotic-use-in-chronic-obstructive-pulmonary-disease-exacerbations-in-the-era-of-antimicrobial-resistance
#14
Jinxiang Wang, Bin Cao
PURPOSE OF REVIEW: This review summarizes the latest discoveries regarding the use of clinical indicators and biomarkers to guide antibiotic use in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and it analyzes the advantages and disadvantages of various indicators and markers. RECENT FINDINGS: For AECOPD patients admitted to emergency departments and medical wards, procalcitonin (PCT)-guided antibiotic therapy reduced antibiotic use without adverse outcomes...
March 2019: Current Opinion in Pulmonary Medicine
https://read.qxmd.com/read/30418243/procalcitonin-and-antibiotics-in-moderate-severe-acute-exacerbation-of-chronic-obstructive-pulmonary-disease-to-use-or-not-to-use
#15
Hiang Ping Chan, Tow Keang Lim
PURPOSE OF REVIEW: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Acute exacerbations of COPD (AECOPD) are major driver for healthcare utilization with each exacerbation begetting the next exacerbation. It is, therefore, important to treat each episode effectively to prevent the next. However, this can be challenging as AECOPD result from complex interactions between host, environment and infective agents. The benefits of starting antibiotics in AECOPD, which are not life-threatening (e...
March 2019: Current Opinion in Pulmonary Medicine
https://read.qxmd.com/read/30489335/heterogeneity-of-nsaid-exacerbated-respiratory-disease-has-the-time-come-for-subphenotyping
#16
Marek L Kowalski
PURPOSE OF REVIEW: NSAID-Exacerbated Disease (N-ERD) is a chronic eosinophilic inflammatory disorder of the respiratory tract occurring in patients with asthma and/or rhinosinusitis with nasal polyps, whose symptoms are exacerbated by NSAIDs. The purpose of this review is to provide an update on clinical characteristics, pathophysiology, and management of N-ERD, and to emphasize heterogeneity of this syndrome. RECENT FINDINGS: Growing evidence indicates that N-ERD, which has been considered a separate asthma phenotype, is heterogenous, and can be divided in several subphenotypes varying in clinical characteristics...
January 2019: Current Opinion in Pulmonary Medicine
https://read.qxmd.com/read/30461535/wrong-inhalation-technique-is-associated-to-poor-asthma-clinical-outcomes-is-there-room-for-improvement
#17
Miguel Román-Rodríguez, Esther Metting, Marina Gacía-Pardo, Janwillem Kocks, Thys van der Molen
PURPOSE OF REVIEW: The long-term goals of asthma management are to control symptoms and to reduce the risk of exacerbations. Inhaled medication is the cornerstone of pharmacological treatment for asthma; therefore, good inhalation technique is the key for asthma management. However, up to 70% of asthma patients do not use their inhalers correctly. There is evidence on how poor inhalation technique is associated to poor asthma control. The purpose of this review is to present the most recent research in this field to help clinicians understand the importance of proper inhalers use and the possible interventions to optimize patients' inhalation technique...
January 2019: Current Opinion in Pulmonary Medicine
https://read.qxmd.com/read/30461532/the-many-faces-of-asthma-chronic-obstructive-pulmonary-disease-overlap
#18
Louis-Philippe Boulet, Nicola A Hanania
PURPOSE OF REVIEW: Asthma and chronic obstructive pulmonary disease (COPD) are common diseases that often overlap. The term asthma-COPD overlap (ACO) has been used to define this entity but there remain several speculations on its exact definition, impact, pathophysiology, clinical features, and management. We reviewed recent publications on ACO to obtain more insight of current knowledge and outline future needs. RECENT FINDINGS: Criteria for ACO vary from one publication to another and the many variable features of these patients underline the need to reconsider the evaluation and approach of patients with overlapping features based on clinical traits and underlying biological mechanisms...
January 2019: Current Opinion in Pulmonary Medicine
https://read.qxmd.com/read/30461531/bronchiectasis-in-severe-asthma-a-distinct-phenotype
#19
Javier Perez-Miranda, Letizia Traversi, Eva Polverino
PURPOSE OF REVIEW: The presence of bronchiectasis has been described in about 30% of severe asthma patients. The coexistence of these two respiratory conditions poses new challenges from both clinical and research perspectives. We will review the available literature on this topic to discuss the existance of a specific clinical phenotype of asthma. RECENT FINDINGS: Despite the paucity of literature, the presence of bronchiectasis with severe asthma is associated with older age, chronic bronchial expectoration, rhinosinusitis, more frequent and severe exacerbations, neutrophilic airway inflammation and poor response to usual treatment...
January 2019: Current Opinion in Pulmonary Medicine
https://read.qxmd.com/read/30461530/oral-corticosteroid-dependent-asthma-current-knowledge-and-future-needs
#20
Ian D Pavord
PURPOSE OF REVIEW: To discuss the current use of oral corticosteroids (OCS) as a chronic treatment in patients with severe asthma and as a rescue treatment for patients presenting with acute exacerbations. RECENT FINDINGS: Airways disease is responsible for the bulk of OCS use in the community and considerable OCS-associated morbidity. I speculate that the key mechanism leading to a beneficial effect in these situations is depletion of circulating eosinophils resulting in a reduced response to potentially inhaled corticosteroid unresponsive recruitment signals to the airway mucosa...
January 2019: Current Opinion in Pulmonary Medicine
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