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Current Opinion in Pulmonary Medicine

Joanne Kavanagh, David J Jackson, Brian D Kent
PURPOSE OF REVIEW: There is a longstanding recognition of the detrimental effect of poorly controlled asthma on sleep, but recent years have seen a growing interest in how asthma and sleep may interact. This review examines the current evidence of relationships between asthma, sleep and sleep disorders. RECENT FINDINGS: Poor quality sleep and sleep disturbance is highly prevalent in asthmatic patients, and particularly in those with severe asthma. Impaired sleep quality correlates with worse asthma control and quality of life...
September 7, 2018: Current Opinion in Pulmonary Medicine
Renata L Riha
PURPOSE OF REVIEW: To explore the evidence for using exogenous melatonin in the treatment of sleep disorders, both primary and secondary, in children and adults. RECENT FINDINGS: A number of recently published meta-analyses have shown that there is evidence for the efficacy of exogenously administered melatonin in a number of sleep disorders. However, melatonin is likely to be prescribed largely for reasons of perceived minimal side-effect profile and very low cost in situations in which high-quality evidence for its usefulness is not forthcoming...
August 24, 2018: Current Opinion in Pulmonary Medicine
Silke Ryan
PURPOSE OF REVIEW: Abnormal sleep duration, including short and long sleep, and sleep disorders, in particular obstructive sleep apnea (OSA), have evolved as major public health concerns attributed to their high prevalence and significant links with mortality and comorbid conditions. There is compelling evidence of an independent association of such sleep disturbances with the development, control, and progression of disorders affecting glucose metabolism such as type 2 diabetes (T2D)...
August 22, 2018: Current Opinion in Pulmonary Medicine
Luciano F Drager, Chi-Hang Lee
PURPOSE OF REVIEW: The aim of this study was to provide an update of the primary and secondary prevention of obstructive sleep apnoea (OSA) treatment on cardiovascular disease. RECENT FINDINGS: Consistent evidence suggest that OSA can contribute to cardiovascular diseases, including hypertension, atrial fibrillation, coronary artery disease and stroke. In patients with no previous history of cardiovascular events (primary prevention scenario), observational studies suggest that continuous positive airway pressure (CPAP), the main treatment for OSA, is able to prevent hypertension incidence and to decrease nonfatal cardiovascular events in men and fatal cardiovascular events in men, women and elderly...
August 18, 2018: Current Opinion in Pulmonary Medicine
Kathryn J Crawford, Damian G Downey
PURPOSE OF REVIEW: The treatment of cystic fibrosis (CF) with CF transmembrane conductance regulator (CFTR) modulators continues to develop at a fast pace. These compounds are potentially disease modifying but are only available to certain patient subsets based on genotype. This review discusses the role of theratyping in CF and the potential to assess all patients' response to current and emerging therapies. RECENT FINDINGS: There are limitations to treatment determined by mutation, as variable clinical response to CFTR modulators has been observed within the same genotype...
August 18, 2018: Current Opinion in Pulmonary Medicine
Sylvia Szentpetery, Patrick A Flume
PURPOSE OF REVIEW: Pulmonary exacerbations are described as worsening of the daily symptoms of cystic fibrosis airways disease, typically with increased cough and sputum production. There are often associated signs such as weight loss and reduced lung function. These events occur frequently and are associated with considerable cost and morbidity. Although approved maintenance therapies are shown to reduce exacerbations, they still occur and are associated with poor outcomes despite treatment...
August 18, 2018: Current Opinion in Pulmonary Medicine
Matthew N Hurley, Alan R Smyth
PURPOSE OF REVIEW: The cystic fibrosis (CF) lung has long been appreciated as a competitive niche for complex interactions between bacterial species. The individual relationships between effects on the host, and thereafter clinical outcomes, has been poorly understood. We aim to describe the role of Staphyloccus aureus, one of the most commonly encountered bacteria cultured from the respiratory tracts of people with CF, and it's complex interplay with other organisms, with particular attention to Pseudomonas aeruginosa...
August 14, 2018: Current Opinion in Pulmonary Medicine
Heather Green, Andrew M Jones
PURPOSE OF REVIEW: The current review examines the current literature around 'emerging' Gram-negative bacteria other than Pseudomonas aeruginosa in cystic fibrosis (CF), paying particular focus on the recent literature for those that are more frequently encountered: Pandoraea, Achromobacter, Ralstonia and Stenotrophomonas species. RECENT FINDINGS: The recent literature is evolving our understanding of the clinical consequences of infection with an 'emerging' Gram-negative bacteria in CF...
August 7, 2018: Current Opinion in Pulmonary Medicine
Lucy Perrem, Jonathan H Rayment, Felix Ratjen
PURPOSE OF REVIEW: In cystic fibrosis, (CF) there is an urgent need for objective tests that can capture and track preclinical lung disease. The lung clearance index (LCI), the primary outcome measure of the multiple breath washout test, is an established endpoint in clinical trials but the clinical utility of the test remains poorly defined. The purpose of this review is to examine the key studies over the past years that have advanced our understanding of the role of the LCI in clinical practice...
August 7, 2018: Current Opinion in Pulmonary Medicine
Claus Moser, Trine Rolighed Thomsen, Niels Høiby
PURPOSE OF REVIEW: The major problem for cystic fibrosis patients is the recurrent and chronic infections of the lungs, determining their prognosis. The challenge from biofilm-growing bacteria and emerging viruses urge the microbiological laboratories to develop better and faster diagnostic tools. Of these, molecular diagnostics are rapidly developing. However, beyond detecting many microorganisms, the task is to evaluate their clinical significance. This has always been a problem resulting in Koch's postulates...
July 31, 2018: Current Opinion in Pulmonary Medicine
Maria Molina-Molina, Raphael Borie
PURPOSE OF REVIEW: Telomere attrition has been proposed as one of the aging hallmarks in pulmonary fibrosis. Telomere shortening and telomerase gene mutations have been widely evaluated in recent years. Reduced telomere length may be identified in a quarter of patients with sporadic idiopathic pulmonary fibrosis (IPF) and half of those cases with family aggregation. However, telomere studies have not transferred from the research field to the clinic. This review is focused on our current understanding of the pathogenic implication of telomere dysfunction in lung fibrosis and its relevance in the clinical setting...
September 2018: Current Opinion in Pulmonary Medicine
Ramon L Ramirez, Vinicio De Jesus Perez, Roham T Zamanian
PURPOSE OF REVIEW: Methamphetamine is a highly addictive drug originally developed for the treatment of neuropsychiatric disorders. At present, the epidemic rise of illicit methamphetamine use has increased the number of patients living with medical complications. Our group has recently identified a definite association between methamphetamine use and pulmonary arterial hypertension (PAH), a life-threatening disease characterized by occlusive vasculopathy and progressive right heart failure...
September 2018: Current Opinion in Pulmonary Medicine
Vasileios Kouranos, Gina Miranda, Tamera J Corte, Elisabetta A Renzoni
PURPOSE OF REVIEW: Interstitial lung disease (ILD) is frequently observed in connective tissue disease (CTD) and is a major cause of mortality. In CTD-ILD, a marked variability in morphological patterns, time course and severity exists. In many patients, CTD-ILD is limited and inherently stable, although a significant proportion of patients have progressive disease. We review the utility of integration of the recently proposed disease behavior classification into the management of CTD-ILD, and recent advances in treatment approaches...
September 2018: Current Opinion in Pulmonary Medicine
Sake J van der Wall, Stephan V Hendriks, Menno V Huisman, F A Klok
PURPOSE OF REVIEW: Historically, because of the necessity of parenteral anticoagulation, patients with acute pulmonary embolism are hospitalized until stable oral anticoagulation is achieved. Despite improvements in prognostic risk stratification and the introduction of the direct oral anticoagulants, home treatment is still not widely applied. Main advantages of home treatment involve improvement of quality of life and significant healthcare cost reduction. In this review, we summarized recent published data on home treatment of patients with acute pulmonary embolism...
September 2018: Current Opinion in Pulmonary Medicine
Simon L F Walsh
PURPOSE OF REVIEW: The application of computer-based imaging analysis in patients with idiopathic pulmonary fibrosis is a rapidly developing field. The purpose of this review is to provide insights into the problems associated with visual interpretation of HRCT patterns and describe some of the current technologies used to provide objective quantification of disease on HRCT. Future directions are also discussed. RECENT FINDINGS: Although there is strong evidence that visual quantification of disease on HRCT in idiopathic pulmonary fibrosis provides prognostic information, this approach is hampered by its subjective nature and interobserver variability...
September 2018: Current Opinion in Pulmonary Medicine
Peter Korsten, Marjolein Drent
No abstract text is available yet for this article.
September 2018: Current Opinion in Pulmonary Medicine
Jason Weatherald, Athénaïs Boucly, Olivier Sitbon
PURPOSE OF REVIEW: Periodic risk stratification is recommended for patients with pulmonary arterial hypertension (PAH). The purpose of this article is to review the available risk stratification tools in PAH. RECENT FINDINGS: Validated tools, such as the REVEAL (Registry to Evaluate Early And Long-term PAH Disease Management) score or European Society of Cardiology/European Respiratory Society (ESC/ERS) risk assessment table incorporate clinical, exercise, imaging, and hemodynamic variables to obtain a multidimensional estimate of prognosis...
September 2018: Current Opinion in Pulmonary Medicine
Vasileios Kouranos, Athol Wells, Simon Walsh
PURPOSE OF REVIEW: In sarcoidosis, the design and validation of an appropriate risk stratification strategy is hampered by the considerable variability in initial presentation, disease evolution, and outcome. Although spontaneous resolution of the disease is described in a large proportion of patients, approximately 20-30% would present with chronic or progressive lung disease that has been associated with morbidity and mortality. Higher morbidity and mortality can be related to both the disease severity and extent as well as its treatments...
September 2018: Current Opinion in Pulmonary Medicine
Sabina A Guler, Christopher J Ryerson
PURPOSE OF REVIEW: Accurate diagnosis of interstitial lung diseases (ILDs) can be challenging, and a substantial percentage of ILD patients remain unclassifiable even after thorough assessment by an experienced multidisciplinary team. In this review, we summarize the recent literature on the definition, prevalence, diagnosis, treatment, and prognosis of unclassifiable ILD, and also discuss important current issues and provide future perspectives on the classification of ILD. RECENT FINDINGS: Approximately 12% of patients with ILD are considered unclassifiable, with large variability across previous studies that is in part secondary to inconsistent definitions of unclassifiable ILD and other ILD subtypes...
September 2018: Current Opinion in Pulmonary Medicine
Peter Korsten, Björn Tampe, Maximilian F Konig, Elena Nikiphorou
PURPOSE OF REVIEW: Sarcoidosis is a rare, multisystem granulomatous disease of incompletely understood pathogenesis. Clinically, it shares common features with several systemic and organ-specific autoimmune diseases, although known autoantibodies or useful serologic markers for diagnosis and monitoring of disease activity are lacking. Sarcoidosis can both coexist with or mimic connective tissue diseases or vasculitis. Here, we review possible common etiologic factors between sarcoidosis and autoimmune disease, comparing clinical, laboratory and imaging features...
September 2018: Current Opinion in Pulmonary Medicine
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