Clinics in chest medicine
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Clinics in chest medicine · Jun 2021
ReviewDiagnosis and Management of Fibrotic Interstitial Lung Diseases.
Nonidiopathic pulmonary fibrosis (non-IPF) progressive fibrotic interstitial lung diseases (PF-ILDs) are a heterogeneous group of ILDs, often challenging to diagnose, although an accurate diagnosis has significant implications for both treatment and prognosis. A subgroup of these patients experiences progressive deterioration in lung function, physical performance, and quality of life after conventional therapy. ⋯ Management of non-IPF P-ILD is both pharmacologic and nonpharmacologic. Antifibrotic drugs, originally approved for IPF, have been considered in patients with other fibrotic ILD subtypes, with favorable results in clinical trials.
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There is growing evidence that palliative care supports the needs of patients with advanced lung cancer. Early palliative care referral has been shown to improve quality of life, decrease symptom burden, and help patients better understand their illness. ⋯ All providers caring for patients with lung cancer should be able to manage basic symptoms and engage in routine discussions about goals of care, prognosis, and suffering. By developing primary palliative care skills, more patients, even those with earlier stages of lung cancer, benefit from better symptom management, communication, support, and quality of life.
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Biomarkers that focus on lung cancer risk assessment, detection, prognosis, diagnosis, and personalized treatment are in various stages of development. This article provides an overview of lung cancer biomarker development, focusing on clinical utility and highlighting 2 unmet clinical needs: selection of high-risk patients for lung cancer screening and differentiation of early lung cancer from benign pulmonary nodules. The authors highlight biomarkers under development and those lung cancer screening and nodule management biomarkers post-clinical validation. Finally, trends in lung cancer biomarker development that may improve accuracy and accelerate implementation in practice are discussed.
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Clinics in chest medicine · Jun 2019
ReviewPhysiologic Effects of Oxygen Supplementation During Exercise in Chronic Obstructive Pulmonary Disease.
Supplemental long-term oxygen therapy (LTOT) is a well-established therapy that improves mortality in patients with chronic obstructive pulmonary disease (COPD) with resting hypoxemia. In the large number of patients with COPD who do not have severe resting hypoxemia but who desaturate with exercise, the clinical benefits that can be obtained by supplemental O2 therapy during exercise is an area of interest and active research. A summary of current evidence for benefits of supplemental O2 therapy and a review of physiologic mechanisms underlying published observations are reviewed in this article.
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Bronchial thermoplasty is an advanced therapy for severe asthma. It is a bronchoscopic procedure in which radiofrequency energy is applied to the airway wall, resulting in decreased airway smooth muscle burden. ⋯ It has been demonstrated to be a safe procedure, with most adverse events being early and mild. More studies are required to understand the precise effects of bronchial thermoplasty on the asthmatic airway and optimal parameters to appropriately select patients for this novel procedure.