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Current Opinion in Pulmonary Medicine

Peter Korsten, Marjolein Drent
No abstract text is available yet for this article.
July 11, 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...
July 11, 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...
July 11, 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...
July 11, 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...
July 5, 2018: Current Opinion in Pulmonary Medicine
Elliott D Crouser
PURPOSE OF REVIEW: A relatively new class of CD4 expressing T cells that also express and release interleukin-17 (Th17 cells) is gaining attention based on their capacity to regulate inflammatory responses in a spectrum of chronic autoimmune diseases. The purpose of this review is to consider recent studies relating to the critical role played by Th17 cells in the pathogenesis of sarcoidosis. RECENT FINDINGS: Th17 cells are unique in their capacity to adapt to local molecular cues to variably promote or suppress inflammation...
July 5, 2018: Current Opinion in Pulmonary Medicine
Yvette C Cozier, Praveen Govender, Jeffrey S Berman
PURPOSE OF REVIEW: Sarcoidosis is a multisystem disease of unknown cause. Obesity can affect many physiological factors. The relationship between obesity and sarcoidosis is unclear, and can been described as posing a 'chicken and egg' scenario for the patient as it is not always clear whether it is a consequence of, or a risk factor for any disease. The purpose of this review is to examine the dual roles of obesity on sarcoidosis morbidity and the incidence. RECENT FINDINGS: Obesity magnifies the symptoms of sarcoidosis and corticosteroid therapy increases BMI...
July 3, 2018: Current Opinion in Pulmonary Medicine
Raoul Bergner, Christian Löffler
PURPOSE OF REVIEW: The purpose of this article is to provide understanding of renal sarcoidosis, the different types of renal sarcoidosis, disease burden of renal involvement, and treatment options. RECENT FINDINGS: The frequency of renal involvement seems to be underestimated, but renal sarcoidosis represents a relevant group of organ manifestations and significantly adds to the patient's morbidity. Because histopathological analysis of renal biopsy specimens can reveal various entities, a diagnostic workup is necessary in every patient with sarcoidosis...
June 29, 2018: Current Opinion in Pulmonary Medicine
Aalt Bast, Khrystyna O Semen, Marjolein Drent
PURPOSE OF REVIEW: Sarcoidosis is a chronic disease, which is routinely treated with corticosteroids. Steroid resistance or steroid-induced adverse effects require alternatives. Other immune-modulating pharmacological treatments have been developed, and therefore expanded tremendously. Until now, the role of nutrition in the overall management of sarcoidosis has been neglected although anti-inflammatory properties of nutritional components have been known for many years now. New nutritional possibilities emerge from already existing data and offer new therapeutic avenues in the treatment of sarcoidosis...
June 22, 2018: Current Opinion in Pulmonary Medicine
Mario Silva, Gianluca Milanese, Nicola Sverzellati
PURPOSE OF REVIEW: The purpose of this review is to provide the radiological description of interstitial lung abnormalities (ILA) as an increasingly reported entity on high-resolution computed tomography (HRCT), and to discuss their prospective interpretation. RECENT FINDINGS: Elementary findings consistent with ILA are described on HRCT, yet the diagnostic confidence for the interpretation of these subtle features might be challenging and further hampered by interobserver variability...
June 22, 2018: Current Opinion in Pulmonary Medicine
Sergio Harari, Paolo Spagnolo, Elisabetta Cocconcelli, Francesca Luisi, Vincent Cottin
PURPOSE OF REVIEW: Lymphangioleiomyomatosis (LAM) is a rare systemic disease that occurs almost exclusively in women. In the last few years, our understanding of disease pathobiology has improved substantially; in addition, a guideline document has recently been developed that provides recommendations for the diagnosis and clinical management of patients with LAM. Yet, significant gaps in knowledge remain. RECENT FINDINGS: Groundbreaking insights into the cellular biochemistry of LAM have led to the reclassification of the disease as a low-grade, destructive, metastasizing neoplasm...
June 20, 2018: Current Opinion in Pulmonary Medicine
Celine Hendriks, Marjolein Drent, Marjon Elfferich, Jolanda De Vries
PURPOSE OF REVIEW: Fatigue is a problem experienced by many patients suffering from chronic diseases, including sarcoidosis patients. It has a substantial influence on patients' quality of life (QoL). It is, therefore, important to properly assess fatigue with a valid and reliable measure. The Fatigue Assessment Scale (FAS) is the only validated self-reporting instrument classifying fatigue in sarcoidosis. The aim of this review was to examine the psychometric properties of the FAS and the diseases and languages in which it has been used...
June 7, 2018: Current Opinion in Pulmonary Medicine
Jeffrey W Clark, Dan L Longo
PURPOSE OF REVIEW: We intend to highlight progress made in 2017 to lung cancer molecular nosology and application of new knowledge to treatment. RECENT FINDINGS: Studies have shown that agents targeting specific molecular defects in lung cancers such as epidermal growth factor receptor(egfr) mutations, alk or ros1 gene rearrangements, are more effective than conventional combination chemotherapy as primary treatment for various lung cancer subgroups. Identification of mechanisms of drug resistance has guided development of improved agents and effective salvage regimens...
July 2018: Current Opinion in Pulmonary Medicine
Hasmeena Kathuria, Frank T Leone, Enid R Neptune
PURPOSE OF REVIEW: The Centers for Medicare and Medicaid Services' requirement to integrate tobacco treatment with lung cancer screening (LCS) has served as a catalyst for motivating pulmonary medicine clinicians to improve upon their ability to effectively treat tobacco dependence. To do so, clinicians need to be well versed in the behavioral and pharmacologic tools that promote smoking cessation. RECENT FINDINGS: The current review outlines current strategies for treating tobacco dependence, focusing on the important interplay between counseling and pharmacotherapy...
July 2018: Current Opinion in Pulmonary Medicine
Varvara Mironova, Justin D Blasberg
PURPOSE OF REVIEW: Ground glass nodules (GGNs) represent an indolent subset of lung nodules including preinvasive nonsmall-cell lung cancer associated with a favorable prognosis and low risk for progression. Increased performance of screening cat-scan (CT) for high-risk patients has identified an increasing number of GGNs. The management of these nodules is founded mostly on single institution data and currently no universally accepted recommendations help guide clinicians managing these patients...
July 2018: Current Opinion in Pulmonary Medicine
Ka Pang Chan, Deirdre B Fitzgerald, Y C Gary Lee
PURPOSE OF REVIEW: Pleural infection remains an important pulmonary disease, causing significant morbidity and mortality. There is a resurgence of disease burden despite introduction of antibiotics and pneumococcal vaccines. A revisit of the pathogenesis and update on intervention may improve the care of pleural infection. RECENT FINDINGS: Recent studies have uncovered the prognostic implication of the presence of a pleural effusion in patients with pneumonia. Identifying where the bacteria lives may have diagnostic and therapeutic implications...
July 2018: Current Opinion in Pulmonary Medicine
Bruce F Sabath, David E Ost
PURPOSE OF REVIEW: The current review describes the latest evidence regarding the use of stents for malignant airway obstruction. RECENT FINDINGS: Therapeutic bronchoscopy, including stenting, can restore patency in up to 93% of patients with malignant central airway obstruction. The patients that benefit the most are those with worse baseline dyspnea, higher American Society of Anesthesiology score, poorer functional status, and central obstruction (rather than lobar)...
July 2018: Current Opinion in Pulmonary Medicine
Duneesha de Fonseka, Nick A Maskell
PURPOSE OF REVIEW: Pleural infection is a common problem associated with significant morbidity and mortality. Systemic or pleural fluid markers for reliably identifying pleural infection are limited. Procalcitonin (PCT) is known to be elevated in bacterial infection and is currently used for diagnosis and decision-making regarding antibiotic duration in respiratory infections. This review investigates if there is a role for serum and pleural fluid PCT (pf-PCT) in diagnosis and management of pleural infection...
July 2018: Current Opinion in Pulmonary Medicine
Vasileios S Skouras, Ioannis Kalomenidis
PURPOSE OF REVIEW: To summarize data regarding categories, detection methods, prevalence and patterns of drug resistance among patients with tuberculous pleural effusion (TPE) and to comment on the management of suspected drug-resistant TPE. RECENT FINDINGS: Pleural and pulmonary tuberculosis (TB) present similar patterns of drug resistance. Approximately 10% and 6-10% of pleural Mycobacterium tuberculosis isolates are resistant to at least one first-line anti-TB drug or at least isoniazid, respectively...
July 2018: Current Opinion in Pulmonary Medicine
Shu-Lan Hsu, Chih-Wei Tseng
PURPOSE OF REVIEW: Hepatic hydrothorax is a nonmalignant pleural effusion associated with portal hypertension that may cause increased morbidity or mortality in cirrhotic patients. For patients who are refractory to salt restriction and diuretics, thoracentesis and catheter drainage are necessary for symptomatic relief. This review aimed to identify the best drainage method in patients with hepatic hydrothorax. RECENT FINDINGS: Chest tube placement is discouraged in cases of hepatic hydrothorax due to high complication and mortality rates...
July 2018: Current Opinion in Pulmonary Medicine
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