Respirology : official journal of the Asian Pacific Society of Respirology
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Silicone airway stents are used to widen narrowed airways in patients with post-tuberculosis tracheobronchial stenosis (PTTS). After mechanical stabilization, stents can be removed from the majority of patients leaving restored airway patency. However, in a significant minority re-stenosis develops post-sten removal thus necessitating surgical intervention or long-term stenting. In this study, we sought to establish prognostic factors for successful airway intervention in PTTS. ⋯ Airway intervention, including silicone stenting, can be successful in patients with PTTS, when the intervention is performed within 1 month of atelectasis and before complete lobar atelectasis.
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Randomized Controlled Trial
Procalcitonin guidance for reduction of antibiotic use in low-risk outpatients with community-acquired pneumonia.
Use of antibiotics in outpatients with community-acquired pneumonia (CAP) is empirical, which may lead to overuse and selection pressure for resistance. Procalcitonin (PCT) levels may predict the severity of CAP and may be used to guide antibiotic use in hospitalized patients. This study evaluated the value of PCT measurements for guiding antibiotic use in low-risk outpatients with CAP. ⋯ Under PCT guidance, antibiotic use was reduced and duration of antibiotic treatment was shortened in low-risk outpatients with CAP, without apparent harm.
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Review
Pleural controversy: pleurodesis versus indwelling pleural catheters for malignant effusions.
Malignant pleural effusions (MPE) are a common complication of advanced malignancy. The treatment of MPE should be focused on palliation of associated symptoms. The traditional approach to MPE has been to attempt pleurodesis by introducing a sclerosant into the pleural space. ⋯ IPC will likely see increasing utilization in the future but patient preference and local resources and expertise will continue to play a significant part in treatment decisions. Randomized trials directly comparing the two approaches are needed and some are underway. Novel combination approaches utilizing both IPC and pleurodesis agents have the potential to further improve the care of these patients.
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Smoking is thought to modify the pattern of airway inflammation. Induced sputum provides useful information on cellular phenotype in inflammatory airways disorders; however, it is time-consuming and difficult to implement in everyday clinical practice. The aim of this study was to determine whether exhaled NO (FeNO) and exhaled breath condensate (EBC) pH differed in asthmatic smokers compared with asthmatic non-smokers and healthy subjects, and to evaluate the performance of FeNO and EBC pH for predicting the cellular phenotype of induced sputum. ⋯ EBC pH and FeNO levels were significantly lower in asthmatic smokers compared with non-smokers. Combined specific cut-off levels for FeNO and EBC pH may predict the paucigranulocytic phenotype in asthmatic smokers.
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Randomized Controlled Trial Multicenter Study
An investigator-driven study of everolimus in surgical lung biopsy confirmed idiopathic pulmonary fibrosis.
We evaluated the efficacy and safety of everolimus, a macrocyclic proliferation signal inhibitor with anti-fibroproliferative activity to prevent disease progression or death in patients with IPF, a progressive, fatal disease with no known effective therapy. ⋯ Everolimus use was associated with more rapid disease progression in a well-defined cohort of patients with IPF confirmed by surgical lung biopsy followed for 3 years.