Chest
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Observational Study
Abnormal Pulmonary Lymphatic Flow in Patients with Lymphatic Anomalies and Respiratory Compromise.
Pulmonary involvement in lymphatic anomalies (LA) is associated with significant morbidity and mortality. Dynamic contrast-enhanced magnetic resonance lymphangiography (DCMRL) is capable of imaging the lymphatic system in a variety of pulmonary lymphatic disorders. ⋯ Clinicaltrials.gov; No.: NCT02744027; URL: www.clinicaltrials.gov.
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Although chronic lung disease is a common cause of mortality, little is known about where individuals with chronic lung disease die. ⋯ Home deaths are rising among decedents from chronic lung disease, increasing the need for quality end-of-life care in this setting. Further research should explore the end-of-life needs and preferences of these patients and their caregivers, with particular attention paid to patients with ILD and CF who continue to have high rates of hospital death.
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Practice Guideline
Chronic Cough Due to Stable Chronic Bronchitis: CHEST Expert Panel Report.
Chronic cough due to chronic bronchitis (CB) causes significant impairment in quality of life, and effective treatment strategies are needed. We conducted a systematic review on the management of chronic cough due to CB to update the recommendations and suggestions of the American College of Chest Physicians (CHEST) 2006 guideline on this topic. ⋯ The evidence supporting the management of chronic cough due to CB is limited overall and of low quality. This article provides guidance on treatment by presenting suggestions based on the best currently available evidence and identifies gaps in our knowledge and areas for future research.
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In patients with a history suggestive of asthma, diagnosis is usually confirmed by spirometry with bronchodilator response (BDR) or confirmatory methacholine challenge testing (MCT). ⋯ In subjects with a self-reported physician diagnosis of asthma, absence of bronchodilator reversibility had a negative predictive value of only 57% to exclude asthma. A finding of spirometric airflow limitation significantly increased chances of asthma. MCT results varied with medication taper and over time, and pulmonologists were sometimes prepared to give a clinical diagnosis of asthma despite negative MCT. Correspondingly, in patients for whom a high clinical suspicion of asthma exists, repeat testing appears to be warranted.
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An 8-year-old boy was referred to our institution because of nausea and vomiting for 1 day. He had also been experiencing shortness of breath for more than 1 year. This symptom had progressed so that he could no longer run or walk upstairs without chest discomfort. ⋯ Echocardiogram 4 years prior suggested mild to moderate biatrial enlargement with trivial mitral valve regurgitation. He did not go in for any follow-up until this admission. He had no other associated diseases, nor use of medicine.