Respiratory medicine
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Respiratory medicine · Jul 2010
Bronchoalveolar lavage in idiopathic pulmonary fibrosis: what does it tell us?
Bronchoalveolar lavage (BAL) has only a limited role in diagnosis of idiopathic pulmonary fibrosis (IPF). A finding of raised neutrophils (>5%) and eosinophils (>2%) is characteristic but not diagnostic of IPF. ⋯ In such cases, it may be diagnostic. Because of few and conflicting results BAL fluid analysis has very little clinical relevance determining prognosis and response to treatment in IPF.
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Respiratory medicine · Jul 2010
Practice GuidelineThe ERS guidelines for LAM: trying a rationale approach to a rare disease.
Lymphangioleiomyomatosis (LAM) is a rare lung disease which predominantly affects young women. LAM is associated with much morbidity and can lead to respiratory failure and death unless lung transplantation is performed. There are no randomised trials of treatment and no consensus on the management of LAM. ⋯ All aspects of management from advice for patients to lung transplantation are discussed. To demonstrate how the guidelines have dealt with different areas of practice and differing evidence levels the specific areas of hormonal therapy, pneumothorax and lung transplantation for LAM are discussed. It is hoped that these guidelines will result in standardisation of diagnostic criteria and patient management which will further improve clinical care and facilitate research and clinical trials.
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The diagnosis of idiopathic pulmonary fibrosis (IPF) currently requires an integrated clinical-radiological-pathological approach in which the histology plays a different role from in the past. The first reason for this change is that non-invasive diagnostic procedures, particularly pulmonary function tests and high resolution computed tomography, have become increasingly competitive with biopsy in providing prognostic information. The other reason is a better appreciation of the limitations of histology: sampling error and interobserver variation. In this review we analyze the reasons for this change of perspective, provide an update on the practical role of histology in the diagnosis of IPF and discuss some of its complications.
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Respiratory medicine · Jul 2010
Randomized Controlled Trial Multicenter StudyCombining tiotropium and salmeterol in COPD: Effects on airflow obstruction and symptoms.
Clinical information on 24-h spirometric efficacy of combining tiotropium and salmeterol compared to single-agent therapy is lacking in patients with COPD. ⋯ Compared to single-agent therapy, combination therapy of tiotropium plus salmeterol in COPD provided clinically meaningful improvements in airflow obstruction and dyspnea as well as a reduction in reliever medication.
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Respiratory medicine · Jul 2010
Randomized Controlled TrialA randomized controlled trial of cognitive behavioral therapy for anxiety and depression in COPD.
Previous research indicates a high prevalence of untreated anxiety and depression in patients with chronic obstructive pulmonary disease (COPD). The current study examined the effect of cognitive behavioral therapy (CBT) in groups for co-morbid, clinically significant anxiety and depression in COPD outpatients of both sexes. ⋯ The findings indicate that CBT may provide rapid symptom relief for COPD patients with clinically significant anxiety and depression, and underline the need for integrating mental health care into the overall medical regimen for COPD.