Expert review of respiratory medicine
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Expert Rev Respir Med · Feb 2013
ReviewEffect of inhaled dry powder mannitol on mucus and its clearance.
Insufficient hydration at the airway surface can make mucus adherent and poorly cleared. Cough, the major mechanism of mucus clearance in disease, is ineffective when mucus is adhesive. Inhaled mannitol creates an osmotic drive for water to move into the airway lumen. ⋯ Inhaled mannitol also promotes effective coughing and stimulates mucociliary clearance. The beneficial effect of mannitol on mucus and its clearance has been demonstrated in patients with asthma, bronchiectasis and cystic fibrosis. Inhaled dry powder mannitol (Bronchitol™) is promising to be an effective treatment for the clearance of retained airway secretions.
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The advent of computed tomography permitted recognition of the coexistence of pulmonary fibrosis and emphysema (CPFE). Emphysema is usually encountered in the upper lobes preceding fibrosis of the lower lobes, and patients are smokers, predominantly male, with distinct physiologic profile characterized by preserved lung volumes and markedly reduced diffusion capacity. Actually, the term CPFE is reserved for the coexistence of any type and grade of radiological pulmonary emphysema and the idiopathic usual interstitial pneumonia computed tomography pattern as well as any pathologically confirmed case. CPFE is complicated by pulmonary hypertension, lung cancer and acute lung injury and may present different outcome than that of its components.
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Expert Rev Respir Med · Feb 2013
Review Case ReportsUse of endobronchial valves in persistent air leaks: a case report and review of the literature.
Air leaks are observed after lung surgery, but can also occur spontaneously even in a previously normal lung. There are several available methods of management including, among others, chest drainage, Heimlich valves, surgical repair or pleural decortication. ⋯ This approach resulted in improvement of dyspnea and exercise capacity. Use of endobronchial valves is an effective, nonsurgical, minimally invasive intervention for patients with prolonged pulmonary air leaks not suitable for surgical procedures.
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Expert Rev Respir Med · Feb 2013
ReviewManaging an acutely ill patient with pulmonary arterial hypertension.
Pulmonary arterial hypertension (PAH) is a progressive disease characterized by a vasculopathy that results in sustained elevation of pulmonary artery pressures, which ultimately leads to right ventricular failure (RVF) and death. Several advances have been made in the treatment of PAH, but it remains a major cause of morbidity and mortality. ⋯ The mechanisms of RVF are incompletely understood; these patients do not tolerate fluid shifts well and there are no controlled trials to assess superiority of a certain approach. This article outlines an approach based on current understanding of RVF in PAH and recommends an approach based on the pathophysiology, current evidence and experience.
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Chronic lung diseases are very common and form a major threat to large proportions of the population with increased morbidity and mortality. Asthma is one of the most common eosinophilic airway diseases. ⋯ Several studies have shown that sputum eosinophilia is associated with a favorable response to treatment of corticosteroids in both asthma and chronic obstructive pulmonary disease, and tailored strategies aimed to normalize sputum eosinophils have resulted in a significant reduction in exacerbation rates. In this article, the authors review the role of eosinophilic inflammation in the diagnosis and management of chronic respiratory diseases.