Current opinion in pulmonary medicine
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The treatment of patients with sarcoidosis remains an important part of management. The role of corticosteroids has been questioned by some, while others have reported its value even in asymptomatic patients with interstitial lung disease. ⋯ A key cytokine in chronic sarcoidosis appears to be tumor necrosis factor. Drugs that inhibit its release or block its effect have been reported as effective for sarcoidosis.
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Malignant pleural effusion is a significant cause of morbidity and a poor prognostic indicator. Traditional treatments have variable success and significant drawbacks, including a length of stay in the hospital. Alternatively, a tunneled pleural catheter permits long-term drainage as an outpatient, cost-effectively controlling the effusion and related symptoms in over 80 to 90% of patients. ⋯ Spontaneous pleurodesis may occur in over 40% of patients, and the catheter can be used to administer sclerosant or antineoplastic agents. Complications tend to be minor and easily managed. A tunneled pleural catheter should be considered for all patients with MPE having a reasonable expectancy of being an outpatient.
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Nosocomial pneumonias are recognized as an important cause of morbidity and mortality in industrialized nations. Emerging data show that they play a similar role in the developing world. ⋯ Recent data suggest that there is no difference in outcome when noninvasive techniques are compared with invasive techniques. Antimicrobial resistance is a rapidly increasing problem globally, and combating this with appropriate antibiotic policies, close surveillance, and physician education is essential.
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Occupational and environmental lung disease is a vast topic. Therefore, this review focuses on areas that represent new clinical insights that have not been addressed recently in Current Opinion in Pulmonary Medicine. The topics are considered important for the future and emphasize diseases that strike large numbers of people or exposures that affect large segments of the population. ⋯ The new world of occupational and environmental lung diseases often involves low levels of exposure to complex mixtures of materials that produce nonspecific or intermittent symptoms in a subgroup of exposed individuals. Interactions between genetic susceptibility, concomitant tobacco smoke exposure, and co-morbid diseases hugely complicate both diagnosis and prevention. New tools, and possibly new thought paradigms, are needed to detect, treat, and prevent occupational and environmental lung diseases in a changing world.
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The Global Initiative for Chronic Obstructive Lung Disease (GOLD) was developed recently to unify international efforts in the management of the disease. The most important GOLD objective is raising awareness that chronic obstructive pulmonary disease is an increasing health problem. The first step in the GOLD program was to prepare a consensus report, named "Global Strategy for the Diagnosis, Management, and Prevention of COPD," based on best-validated evidence and current pathogenetic and clinical knowledge. It encourages implementation of effective strategies for prevention, diagnosis, and management of the disease in all countries, and emphasizes the importance of renewed research initiatives.