Chest
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Review
How I Do It: Managing Cavitary Coccidioidomycosis Expert Opinions for Improving Patient Outcomes.
Coccidioidomycosis (CM), caused by the dimorphic fungi Coccidioides immitis (C. immitis) and C. posadasii, is recognized as an increasing threat both nationally and worldwide. This is in large part secondary to the expanding range of Coccidioides spp. and increased international travel to endemic regions. The majority of individuals exposed to airborne Coccidioides organisms do not need medical attention, but approximately 30% will develop primary pulmonary coccidioidomycosis (PCM) with signs and symptoms that mimic community acquired pneumonia (CAP) or other respiratory illnesses. ⋯ Despite the long-term consequences of cavitary CM in some individuals, the current literature review and practice guidelines demonstrate a paucity of clear management strategies to treat these patients. In this report we will focus on cavitary lesions in CM with the goal to present a description of the evaluation and management of their various forms, manifestations, and complications. These recommendations are derived from a multidisciplinary group of experts.
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Low-dose morphine may be prescribed to reduce chronic breathlessness in chronic obstructive pulmonary disease (COPD). Recent subjective findings suggest morphine may influence breathlessness through sleep-related mechanisms. However, concerns exist regarding opioid safety in COPD. The effects of morphine during sleep in COPD have not been objectively investigated. This study aimed to objectively determine the effects of low-dose morphine on sleep. ⋯ Steady-state, low-dose morphine does not change sleep efficiency, sleep-disordered breathing frequency, or next day alertness but may cause hypoventilation during sleep, a potentially harmful effect.
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The screening strategy for interstitial lung disease (ILD) in rheumatoid arthritis patients is currently debated. While high-resolution computed tomography (HRCT) is the gold standard for diagnosing ILD, its systematic use as a screening tool is not yet recommended. The role of lung ultrasound (LUS) in assessing ILD has been previously explored. ⋯ LUS is a promising tool for ILD screening in asymptomatic rheumatoid arthritis patients, offering high sensitivity and negative predictive value. Its incorporation into routine clinical practice could optimise ILD screening strategies and enhance patient outcomes through early detection and intervention.
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Annual lung cancer screening using low dose computed tomography (LDCT) effectively reduces mortality from lung cancer and is recommended for persons who are at high risk of developing the disease. The utilization of the lung cancer screening, however, has remained low. Due to significantly higher cigarette smoking rates, patients with behavioral health disorders (those living with mental illness and/or substance use disorders) are more likely to be diagnosed with and die from lung cancer; at the same time, they are less likely to undergo cancer screenings. ⋯ Regardless of the level of engagement, possibly ranging from brief training to the implementation of comprehensive programs, any involvement will benefit patients. This integrated approach will contribute to reducing lung cancer mortality among patients with behavioral health disorders who have long experienced systemic health inequities. Lung Cancer Screening Recommendations and Current Uptake.
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Asthma is a common multifaceted respiratory disease with a major impact on quality of life. Despite increased insights into mechanisms underlying various asthma phenotypes/endotypes and the availability of targeted biologic treatment options, a substantial proportion of patients remains uncontrolled with risk of exacerbations, requiring systemic corticosteroids, and progressive disease. Current international guidelines advocate a personalized management approach to patients with uncontrolled severe asthma. ⋯ The EUFOREA asthma expert panel was convened to discuss strategies to optimize asthma care, prevent systemic corticosteroids overuse and disease progression. In this meeting report, we summarize current concepts and recommendations and provide a rationale to implement personalized asthma management at earlier stages of the disease. The ultimate goal is to move away from the current "one-size-fits-most" concept, which focuses on a symptom-driven treatment strategy, and shift towards a phenotype/endotype-targeted approach aimed at curbing the disease course by improving clinical outcomes and preserving health-related quality of life.