The Medical clinics of North America
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Med. Clin. North Am. · Nov 2022
ReviewHypersensitivity Pneumonitis: An Updated Diagnostic Guide for Internists.
This summary highlights updated definitions, terminology, and classification systems proposed in the diagnosis of hypersensitivity pneumonitis. Clinical presentation, epidemiology, and pathophysiology are reviewed from the most recent data. ⋯ The role of adjunctive tests, such as serum IgG testing, bronchoalveolar lavage lymphocyte analysis, and pulmonary function testing is discussed in the context of supporting diagnostic confidence for hypersensitivity pneumonitis diagnosis. Finally, new diagnostic algorithms are synthesized and applied to the general internal medicine setting.
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Med. Clin. North Am. · Nov 2022
ReviewDisparities in Disease Burden and Treatment of Patients Asthma and Chronic Obstructive Pulmonary Disease.
Lung health reflects the inequities of our society. Asthma and chronic obstructive pulmonary disease are 2 lung conditions commonly treated in general clinical practice; each imposes a disproportionate burden on disadvantaged patients. ⋯ Members of racial/ethnic minorities and those of low socioeconomic status also have inferior access to high-quality medical care, compounding disparities in disease burden. Physicians can work against disparities in their practice, but wide-ranging policy reforms to achieve better air quality, housing, workplace safety, and healthcare for all are needed to achieve equity in lung health.
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Med. Clin. North Am. · Nov 2022
ReviewAdvances in Evaluation and Treatment of Severe Asthma (Part One).
As many as 15% to 20% of patients with asthma have incompletely or poorly controlled asthma despite treatment with inhaled corticosteroids and long-acting beta-agonist bronchodilators. They are vulnerable to burdensome symptoms, limitations to their exercise capacity, and asthma attacks that can be frightening and potentially life-threatening. ⋯ This approach includes an emphasis on ensuring the correct diagnosis, minimizing exposures to stimuli that worsen airway inflammation, alleviating modifiable comorbidities such as chronic rhinosinusitis and gastroesophageal reflux, and supporting regular medication adherence and effective technique for administering inhaled medications. A basic diagnostic laboratory work-up is recommended, to be modified and amplified according to individual patient needs.
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Med. Clin. North Am. · Nov 2022
ReviewAdvances in Evaluation and Treatment of Severe Asthma (Part Two).
Providers caring for patients with severe, therapy-resistant asthma have novel options for their treatment. Administration of additional inhaled corticosteroids at the time of increased symptoms, a strategy referred to as anti-inflammatory rescue or AIR, has been proved to be effective in reducing the frequency of exacerbations and improving asthma-related quality of life. Long-acting muscarinic antagonists can be used in combination with long-acting beta-agonist bronchodilators for additional bronchodilation. The care of the patient with severe asthma must also include a strategy to help avoid severe, life-threatening asthma attacks, with intense patient education and a recommended survival toolkit.
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In late 2019, SARS-CoV-2 caused the greatest global health crisis in a century, impacting all aspects of society. As the COVID-19 pandemic evolved throughout 2020 and 2021, multiple variants emerged, contributing to multiple surges in cases of COVID-19 worldwide. ⋯ Treatment options have been rapidly explored, attempting to repurpose preexisting medications in tandem with development and evaluation of novel agents. Care of the seriously ill patient is examined.