Clinics in chest medicine
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Any COPD patient with symptoms is a candidate for pulmonary rehabilitation. A careful assessment of the individual to determine the patient's precise disease process and needs is essential to outlining an appropriate treatment program. Following the sequence described in the ATS Statement on Pulmonary Rehabilitation included in the appendix to this article provides the best potential for successfully returning the patient to the highest level of function possible. An increase in the availability of pulmonary rehabilitation programs should allow more COPD patients to participate in this process, resulting in an enhanced ability to carry out daily activities, an improved quality of life, and a reduction in the long-term costs of caring for such individuals.
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Lung transplantation has evolved from an intellectual curiosity to a viable therapeutic option in a selected number of patients with end-stage lung disease. The indications for single lung, double lung, or heart-lung transplantation at major North American transplant centers are presented, the selection criteria are discussed, and the standard preoperative evaluation is outlined. Utilizing these guidelines, a 1-year actuarial survival following each of these procedures of greater than 60% can be expected.
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Clinics in chest medicine · Jun 1990
ReviewInfectious complications in pulmonary allograft recipients.
This article has outlined the features of the major types of infections encountered in pulmonary allograft recipients. Virtually any pathogen can cause infection in these immunocompromised subjects, and there is a distinct propensity for these organisms to invade the transplanted lung. As is the case with other major organ recipients, there is a temporal sequence in the types of infection lung allograft recipients contract. ⋯ Despite these relative successes, however, the risk for infection of the allograft remains high because the defense mechanisms in the lung allograft are breached by the effects of surgery, the "allogeneic environment" in the allograft and systemic immunosuppression, and the fact that chronic rejection causes structural changes that predispose to bacterial colonization of the airways and the need for increased levels of immunosuppression. Despite the formidable barrier that infection of the lung allograft poses, the procedure of pulmonary transplantation clearly holds sufficient promise that all efforts possible should be made to hurdle this barrier. Achieving such a goal would ensure a place for pulmonary transplantation in the armamentarium of treatment for irreversible pulmonary disease.
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Over 100 drugs can impair muscle function, either by inhibiting neural drive, causing peripheral neuropathy, blocking neuromuscular junctions, precipitating myasthenia gravis, or producing myopathy. Many of these drugs affect respiratory muscles, particularly the diaphragm. ⋯ This article has reviewed what is known about the effects of drugs on respiratory myoneural function and what can be inferred from studies on other striated muscles. We hope that this review serves to stimulate further investigation; meanwhile, until more is known, continued clinical caution is justified.
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Clinics in chest medicine · Dec 1989
ReviewRespiratory infections and acute lung injury in systemic illness.
We have discussed the relationship between systemic illness, infection, and lung disease. As we have seen, patients with a wide variety of disease states, including advanced age, diabetes mellitus, alcoholism, collagen vascular disease, cancer, heart failure, and organ transplantation are potentially at increased risk for pneumonia because of disease-related impairments in host defenses. In addition, two virtually ubiquitous conditions in hospitalized patients, malnutrition and therapeutic interventions (especially with common medications), frequently add to the risk of airway invasion by bacterial pathogens. ⋯ Although it is frequently impossible to predict which specific patient with systemic sepsis will develop acute lung injury, the current state of knowledge does permit us to identify high-risk individuals. Surprisingly, clinical assessment rather than biochemical testing is the best predictor of the development of acute lung injury. Patients with severe injury, profound shock and multiple systemic insults are most prone to acute lung injury in the presence of systemic sepsis.(ABSTRACT TRUNCATED AT 400 WORDS)