The Medical clinics of North America
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Med. Clin. North Am. · Nov 2022
ReviewCystic Fibrosis: Highly Effective Targeted Therapeutics and the Impact on Sex and Racial Disparities.
People with Cystic Fibrosis (CF) are living longer and healthier lives due in part to new therapies, called Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) modulators. However, disparities in outcomes still exist, with females demonstrating a shorter life expectancy than males; this is opposed to the typical female versus male life expectancy in the general United States population. In addition, minority populations such as those of Hispanic ethnicity and African Americans are less frequently eligible for these new CFTR modulators. The mechanisms driving this difference and the relative contribution of CFTR to the etiology are not yet elucidated.
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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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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.
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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
ReviewThe Role of Long-Term Noninvasive Ventilation in Chronic Stable Hypercapnic Chronic Obstructive Pulmonary Disease.
Despite the heterogeneity of data on the role of noninvasive ventilation (NIV) in severe stable chronic obstructive pulmonary disease with chronic hypercapnia, the current evidence supports the use of NIV in select populations and phenotypes. The Center for Medicare and Medicaid Services reimbursement criteria are complex, and the practice of navigating the most efficient method to initiate NIV therapy continues to be challenging. These patients optimally require referral to a medical center that has physicians with specific training in pulmonary and sleep medicine, who can navigate the specific needs for the use of NIV.