Clinics in chest medicine
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Clinics in chest medicine · Sep 2010
ReviewPulmonary manifestations of systemic lupus erythematosus.
Systemic lupus erythematosus (SLE) is a potentially severe, frequently disabling autoimmune disease with multiorgan involvement and a typically waxing and waning course. SLE is often considered the prototypical autoimmune disease. Although SLE has the potential to affect any organ, the lungs are commonly involved later in the course of the disease in the setting of other organ involvement. ⋯ The most common pulmonary manifestation attributable to SLE is pleuritis, but other pleural involvement can be seen, as well as parenchymal disease, pulmonary vascular disease, diaphragmatic dysfunction, and upper airway dysfunction. Finding the true prevalence of lung involvement with SLE is complicated by the high rates of pulmonary infections. This article reviews the diverse clinical symptoms and immunologic pulmonary manifestations of SLE.
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Clinics in chest medicine · Sep 2010
ReviewPulmonary manifestations of the idiopathic inflammatory myopathies.
Pulmonary involvement in myositis includes interstitial lung disease (ILD), respiratory muscle weakness, aspiration, infections, and drug-induced disease. ILD may precede myositis, and results in increased morbidity and mortality rates. ⋯ Nonspecific interstitial pneumonia (NSIP) is the most common histologic pattern on lung biopsy. Treatment usually consists of a combination of steroids and other immunosuppressive agents, and the response depends on the clinical presentation and underlying histology.
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A wide variety of mechanisms can lead to the hypoventilation associated with various medical disorders, including derangements in central ventilatory control, mechanical impediments to breathing, and abnormalities in gas exchange leading to increased dead space ventilation. The pathogenesis of hypercapnia in obesity hypoventilation syndrome remains somewhat obscure, although in many patients comorbid obstructive sleep apnea appears to play an important role. ⋯ Central alveolar hypoventilation syndrome involves a genetically determined defect in central respiratory control. Treatment in all of these disorders involves coordinated management of the primary disorder (when possible) and, increasingly, the use of noninvasive positive pressure ventilation.
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Clinics in chest medicine · Jun 2010
Ambulatory management of patients with sleep apnea: is there a place for portable monitor testing?
Portable monitor testing is being increasingly used as an alternative strategy for the diagnosis and treatment of patients with obstructive sleep apnea. Portable monitors have become progressively sophisticated but lack standardization. Recent studies comparing clinical outcomes of ambulatory management pathways using portable monitor testing support their use in patients with a high pretest probability for obstructive sleep apnea. Whether ambulatory management is cost-effective and will improve patient access to diagnosis and treatment requires further investigation.
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Central apnea is caused by temporary failure in the pontomedullary pacemaker generating breathing rhythm, which results in the loss of ventilatory effort, and if it lasts 10 seconds or more it is defined as central apnea. This article reviews current knowledge on central sleep apnea.