Annals of the American Thoracic Society
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Recent literature suggests vitamin D has an effect on lung function and on the lung's ability to fight infection, both important in the cystic fibrosis (CF) population as predictors of morbidity and mortality. ⋯ Higher 25-OHD levels in children with CF were associated with lower rates of pulmonary exacerbations and, in adolescents, higher FEV1.
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Historical Article
The Surgeon Generals' reports and respiratory diseases. From 1964 to 2014.
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Coccidioidomycosis is a common cause of community-acquired pneumonia in the southwest United States, Mexico, and South America. The disease has seen a marked increase in incidence in the western United States in the last decade and can be acquired by individuals who travel even briefly through an endemic area, presenting a diagnostic dilemma for clinicians who are not familiar with the disease. The clinical and radiographic manifestations of pulmonary coccidioidomycosis often mimic those of other causes of pneumonia. ⋯ The sensitivity of serologic testing is lower in immunocompromised patients, a population at the highest risk for developing severe disease. When clinically appropriate, other biologic specimens, such as sputum, bronchoalveolar lavage fluid, or lung biopsies, may allow for rapid, definitive diagnosis. In light of the significantly increased incidence and complexities in diagnosis of coccidioidomycosis, we examine the diagnostic approach and provide examples of classic clinical and radiographic presentations, discuss the utility of serologic testing, and suggest algorithms that may aid in the diagnosis.
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Observational Study
An index of daily step count and systemic inflammation predicts clinical outcomes in chronic obstructive pulmonary disease.
Identification of persons with chronic obstructive pulmonary disease (COPD) at risk for acute exacerbations (AEs) targets them for close monitoring. ⋯ An index combining daily step count and systemic inflammation can predict AEs and COPD-related hospitalizations. A validation study in a separate cohort is needed to confirm the utility of the proposed index as a clinical tool to risk stratify persons with COPD.
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Time-varying demand for critical care may strain the capacities of intensive care units (ICUs) to provide optimal care. Intensivists and ICU nurses may be the best judges of the strain on their ICU. Yet, it is not clear what ICU and hospital factors contribute to this perceived sense of strain among ICU providers. ⋯ A model containing commonly available metrics of ICU census, average patient acuity, and the proportion of new admissions has validity as a model of ICU nurses' perceived ICU capacity strain. However, only ICU census was associated with increased perceived capacity strain by physicians, highlighting the need for involvement of multiple stakeholder groups to improve our understanding of ICU capacity strain.