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Response to pulmonary rehabilitation is not equal for all participants, and may vary across health outcomes for any one individual. Alternative modes of pulmonary rehabilitation delivery, e.g. telerehabilitation, may improve program access but could also affect response to rehabilitation. ⋯ Responder status to pulmonary rehabilitation was not different between center-based and home-based telerehabilitation, although rehabilitation completion was higher for home-based telerehabilitation. Identifying participant features that confer greater potential for rehabilitation response, or better suitability for a particular model of rehabilitation, remains a challenge.
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There are limited FDA-approved medications and real-world data on sarcoidosis treatment in the U.S. and concordance of practice patterns with guideline recommendations have not been well characterized. ⋯ Within the first year of diagnosis, 43% of patients with sarcoidosis were started on treatment. Non-steroidal immunosuppressives were used in 40% of treated patients. While factors associated with treatment initiation aligned with guideline recommendations, practice patterns of treatment were variable, particularly in choice and sequence of non-steroidal immunosuppressive therapy, underscoring the need for future trials and comparative effectiveness studies.
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Parasitic infections in the United States are mostly seen in immigrants and travelers. In many cases, pulmonary and intensive care physicians fail to consider parasitic disease, which can result in delayed diagnosis and adverse outcomes. Almost 2,000 cases of imported malaria are diagnosed in the United States each year. ⋯ Endemic regions include not only East Asia, but also Southeast Asia, west Africa, the Pacific coast of Latin America, and even North America. Other parasitic infections can involve the lungs. This article aims to provide awareness of the most clinically relevant parasitic infections seen in pulmonary and critical care medicine.
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Interstitial lung diseases (ILDs) represent a broad group of heterogeneous parenchymal lung diseases. Some ILDs progress, causing architectural distortion and pulmonary fibrosis, thus are called fibrotic ILDs. Recent studies have shown a beneficial effect of antifibrotic therapy in fibrotic ILDs other than Idiopathic Pulmonary Fibrosis (IPF) that manifest progressive pulmonary fibrosis (PPF). However, it is still challenging to predict which patients with fibrotic ILDs will manifest PPF. Precision medicine approaches could identify patients at risk for progression and guide treatment in patients with IPF or PPF. ⋯ Substantial progress has been observed in the context of precision medicine approaches in fibrotic ILDs during the last years. Nonetheless, there are still infrastructure, financial, regulatory and ethical challenges to overcome for the implementation of precision medicine in the clinical practice. Overcoming such barriers and moving from ''one-size fits all'' approach to a patient-centered care could substantially improve patient's quality of life and survival.
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Sarcoidosis is an idiopathic multiorgan disease with variable clinical outcomes. Comprehensive analysis of sarcoidosis mortality in U.S. Veterans is lacking. ⋯ Mortality among Veterans with sarcoidosis is rising. Differences identified by service branch and higher risk among male Veterans raise questions about differences in environmental exposures. The narrower racial disparities and smaller impact of ADI than in other studies may highlight the role of universal healthcare access in achieving equitable outcomes.