Expert review of respiratory medicine
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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.
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Expert Rev Respir Med · Feb 2013
The role of systemic inflammatory biomarkers to predict mortality in chronic obstructive pulmonary disease.
The authors discuss the role of inflammatory biomarkers to predict mortality in chronic obstructive pulmonary disease (COPD) in this narrative literature review with expert opinion. The severity of COPD has traditionally been graded using the degree of obstruction as measured by the forced expiratory volume in 1 s because this variable has been predictive of outcomes. However, it is now accepted that COPD is a complex disease with important systemic consequences and that a multidimensional index such as the BMI, obstruction, dyspnea and exercise capacity index is a better predictor of outcome than lung function alone. ⋯ Of the ones studied, C-reactive protein, IL-6, pulmonary and activation-regulated chemokine and fibronectin:C-reactive protein ratio have been observed to be independently associated with increased risk of death. When added to known clinical variables such as the BMI, obstruction, dyspnea and exercise capacity index, only IL-6 has been shown to further contribute to mortality prediction. It is likely that the use of an integrative approach combining biomarkers investigated through high-output technology with clinical parameters, combined with new information from the fields of genomics, transcriptomics, proteomics and metabolomics, will improve the authors capacity to predict mortality in COPD.
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The propensity of various nontuberculous mycobacteria to cause lung disease varies widely and is conditioned by host factors; infection is believed to occur from environmental sources. Nontuberculous mycobacteria pulmonary disease (PNTM) is increasing worldwide and Mycobacterium avium complex is the most common cause. PNTM usually occurs in one of three prototypical forms: hypersensitivity pneumonitis, cavitary tuberculosis-like disease or nodular bronchiectasis. ⋯ Clinical trials are lacking to inform treatment for many species and experience with M. avium complex and several others species serves as a guide instead. Use of multiple drugs for a period of at least 12 months following sputum conversion is the norm for most species. In vitro drug susceptibility results for many drugs may not correlate with clinical outcomes and such testing should be done on a selective basis.