Expert review of respiratory medicine
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Bronchiectasis is a common disease with important impacts on patient's quality of life and on healthcare systems in terms of healthcare costs, hospitalisations and mortality. After decades of being regarded as an orphan disease there are an increasing numbers of treatments available, or in late-stage clinical trials. Assessment of disease severity is fundamental to clinical management. ⋯ These terms are often applied to radiological appearances, but while important, computed tomography findings are not sufficiently precise to capture the complex impact of the disease. Studies are beginning to define the risk factors for mortality, hospital admissions, exacerbations and impaired quality of life in bronchiectasis, allowing us to propose new definitions of what constitutes severe bronchiectasis. An improved understanding of severity and prognosis in this disease will aid clinical decision making and the application of new therapies.
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Expert Rev Respir Med · Apr 2014
The clinical utility of bronchoalveolar lavage in interstitial lung disease - is it really useful?
Bronchoalveolar lavage (BAL) can be a very useful tool in the diagnosis of interstitial lung disease, but BAL must be performed properly and the retrieved BAL fluid adequately processed and analyzed to allow accurate conclusions to be drawn from BAL analysis. A differential cell count of nucleated immune cells can show cell patterns that suggest or support certain diagnoses, and other testing (stains and cultures for infectious pathogens, malignant cell cytology) can be performed on BAL fluid that can also aid in diagnosis. When combined with the results of a careful history, physical examination, thoracic imaging, and other pertinent laboratory testing, the BAL analysis may allow a confident diagnosis of a specific interstitial lung disease to be made without proceeding to more invasive testing (e.g., surgical lung biopsy) that is associated with increased risk of complications.
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Expert Rev Respir Med · Feb 2014
ReviewThe use of portable monitoring for sleep apnea diagnosis in adults.
Due to increasing demand for sleep services, there has been growing interest in ambulatory models of care for patients with obstructive sleep apnea (OSA). The implementation of alternative approaches to the current management by full polysomnography (PSG) in the sleep laboratory is necessary for diagnosing this syndrome due to the high cost of full-night PSG. ⋯ PM may be recommended as an alternative method to PSG for patients with high clinical risk for OSA. In the present review, we describe the use of PM for OSA diagnosis and evaluate the current progress, costs, limitations and applications of these devices in various groups of patients, particularly for patients with comorbid diseases.
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Expert Rev Respir Med · Dec 2013
ReviewTai Chi as a form of exercise training in people with chronic obstructive pulmonary disease.
Tai Chi is an ancient Chinese martial art which incorporates elements of strengthening, balance, postural alignment and concentration. The benefits of Tai Chi in the healthy population have been widely examined. ⋯ Furthermore, a short-term program of Tai Chi improves exercise capacity, health-related quality of life, balance and quadriceps strength in people with mild to moderate COPD. More studies are warranted to examine the effects of different styles of Tai Chi and the long-term benefits of Tai Chi as an exercise regimen for people with COPD.
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Expert Rev Respir Med · Dec 2013
Case ReportsRespiratory failure due to blastomycosis infection in a patient with hypertension, cirrhosis and chronic pancreatitis.
Blastomycosis is an endemic fungal infection in North America. It usually causes acute and occasionally chronic pneumonias with disseminated infection, particularly skin lesion, as an extrapulmonary manifestation. Many cases are asymptomatic; however, a few patients progress to develop severe pulmonary infection leading to acute respiratory distress syndrome, which carries a high mortality rate. ⋯ In our patient, it was practically impossible to establish a diagnosis of cardiac blastomycosis antemortem because of his previous cardiac history related to alcoholic cardiomyopathy, which confounded the cardiac findings. This case raises an important issue of clinically considering involvement of the heart in cases of disseminated blastomycosis. Perhaps if the patient did not have a prior cardiac history, a new onset heart failure may have suggested cardiac involvement.