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Current Opinion in Pulmonary Medicine

Marjolein Drent, Petal Wijnen, Aalt Bast
PURPOSE OF REVIEW: Fibrosing interstitial pneumonias are associated with various stages of fibrosis. The cause of this group of syndromes remains largely unknown. For most of these diseases, a genetic basis, environmental factors and certain triggers have been suggested as possible risk factors. Various studies have found an association between genetic polymorphisms, or the presence of certain variant alleles, and the occurrence and/or progression of interstitial pneumonias of unknown origin...
March 13, 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...
March 13, 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)...
March 13, 2018: Current Opinion in Pulmonary Medicine
Carlos M Luna, Laura Pulido, Diego Burgos
PURPOSE OF REVIEW: As Streptococcus pneumoniae was considered the etiological agent of nearly all the cases of pneumonia at the beginning of the 20th century, and today is identified in fewer than 10-15% of cases, we analyze the possible causes of such a decline. RECENT FINDINGS: Extensive use of early empiric antimicrobial therapy, discovery of previously unrecognized pathogens, availability to newer diagnostic methods for the recognition of the pneumonia pathogens (PCR, urinary antigens, monoclonal antibodies etc...
March 13, 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...
March 9, 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...
March 9, 2018: Current Opinion in Pulmonary Medicine
Adam Mutsaers, Hanbo Chen, Alexander V Louie
PURPOSE OF REVIEW: Significant advances have been made in the field of stereotactic ablative radiotherapy (SABR) for the treatment of pulmonary neoplasms in recent years. This review aims to summarize recent salient evidence on SABR for early-stage nonsmall cell lung cancer (ES-NSCLC). RECENT FINDINGS: In medically inoperable patients, SABR remains the standard of care. The optimal SABR dosing regimen is being studied. Comparisons with non-SABR radiotherapy regimens with lower doses per fraction revealed benefit of SABR...
March 7, 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...
March 7, 2018: Current Opinion in Pulmonary Medicine
José M Porcel
PURPOSE OF REVIEW: To provide an overview of the contribution of thoracic ultrasound (TUS) and computed tomography (CT) in the identification of complicated parapneumonic effusions (CPPE), defined as those which need chest tube drainage for resolution. RECENT FINDINGS: A recent retrospective study found that visualization of complex (nonanechoic) effusions on TUS (likelihood ratio positive = 6.92) outperformed the recognition of loculated/septated effusions on CT (likelihood ratio = 2...
March 6, 2018: Current Opinion in Pulmonary Medicine
Coline H M van Moorsel
PURPOSE OF REVIEW: The process of aging involves biological changes that increases susceptibility for disease. In the aging lung disease IPF, GWAS studies identified genes associated with risk for disease. Recently, several of these genes were also found to be involved in risk for COPD or lung cancer. This review describes GWAS-derived risk genes for IPF that overlap with risk genes for lung cancer or COPD. RECENT FINDINGS: Risk genes that overlap between aging lung diseases, include FAM13A, DSP and TERT...
March 6, 2018: Current Opinion in Pulmonary Medicine
Nadia Nathan, Keren Borensztajn, Annick Clement
PURPOSE OF REVIEW: Interstitial lung disease (ILD) in children (chILD) is an umbrella term for a heterogeneous group of rare respiratory disorders that are mostly chronic and associated with high morbidity and mortality. The pathogenesis of the various chILD is complex and implicates genetic contributors. The purpose of this review is to provide updated information on the molecular defects associated with the development of chILD. RECENT FINDINGS: Currently, the main mutations are identified in the surfactant genes SFTPA1, SFTPA2, SFTPB, SFTPC, ABCA3, and NKX2-1...
March 6, 2018: Current Opinion in Pulmonary Medicine
Fernando A L Marson
PURPOSE OF REVIEW: To compile data from the past 10 years regarding the role of modifying genes in cystic fibrosis (CF). RECENT FINDINGS: CF is a model disease for understanding of the action of modifying genes. Although it is a monogenic (CFTR) autosomal recessive disease, CF presents with wide phenotypic variability. In CF, variability occurs with different intensity among patients by each organ, being organ-specific, resulting from the mutual interaction of environmental and genetic factors, including CFTR mutations and various other genes, most of which are associated with inflammatory processes...
March 6, 2018: Current Opinion in Pulmonary Medicine
Thijs W Hoffman, Coline H M van Moorsel, Raphael Borie, Bruno Crestani
PURPOSE OF REVIEW: Genomic mutations in telomere-related genes have been recognized as a cause of familial forms of idiopathic pulmonary fibrosis (IPF). However, it has become increasingly clear that telomere syndromes and telomere shortening are associated with various types of pulmonary disease. Additionally, it was found that also single nucleotide polymorphisms (SNPs) in telomere-related genes are risk factors for the development of pulmonary disease. This review focuses on recent updates on pulmonary phenotypes associated with genetic variation in telomere-related genes...
February 21, 2018: Current Opinion in Pulmonary Medicine
Steven Kroon, Repke J Snijder, Marie E Faughnan, Hans-Jurgen Mager
PURPOSE OF REVIEW: Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant inherited disease characterized by telangiectasia and arteriovenous malformations (AVMs). To date, five genetic types of HHT and one combined juvenile polyposis syndrome and HHT are known. Clinical and genetic screening of patients suspected with HHT is recommended to confirm the diagnosis and to prevent complications associated with HHT. The aim of this article is to give an overview of the evidence and to formulate a recommendation for clinicians concerning screening for HHT...
February 20, 2018: Current Opinion in Pulmonary Medicine
Noah A Brown, Kojo S J Elenitoba-Johnson
PURPOSE OF REVIEW: Langerhans cell histiocytosis (LCH) is a neoplasm of dendritic cells with a wide clinical spectrum. Localized pulmonary LCH occurs in young adults with a history of smoking and can either resolve spontaneously or lead to progressive decline in pulmonary function. Young children can also present with localized disease - frequently bone or skin - or with multifocal or multisystem disease. Clinical outcomes in these patients also vary widely, ranging from spontaneous resolution to multiorgan failure and death...
February 20, 2018: Current Opinion in Pulmonary Medicine
Julio A Ramirez
PURPOSE OF REVIEW: The primary challenges in the field of clinical research include a lack of support within existing infrastructure, insufficient number of clinical research training programs and a paucity of qualified mentors. Most medical centers offer infrastructure support for investigators working with industry sponsors or government-funded clinical trials, yet there are a significant amount of clinical studies performed in the field of pneumonia which are observational studies...
February 20, 2018: Current Opinion in Pulmonary Medicine
Mark H Adelman, Doreen J Addrizzo-Harris
PURPOSE OF REVIEW: To highlight recent original research and specialty society guidelines regarding the diagnosis and treatment of nontuberculous mycobacterial (NTM) pulmonary disease. RECENT FINDINGS: The prevalence of NTM pulmonary disease has risen in recent years. The prevalence of individual NTM species varies geographically, although Mycobacterium avium complex (MAC) and Mycobacterium abscessus complex (MABC) remain among the most commonly encountered in many regions...
February 20, 2018: Current Opinion in Pulmonary Medicine
Emanuele Pontali, Dina Visca, Rosella Centis, Lia D'Ambrosio, Antonio Spanevello, Giovanni Battista Migliori
PURPOSE OF REVIEW: Multidrug-resistant (MDR) tuberculosis (TB) and extensively drug-resistant (XDR)-TB epidemics are key obstacles towards TB control and elimination. RECENT FINDINGS: Diagnosis of MDR/XDR-TB is difficult and requires several weeks. New diagnostic tools are being tested and proposed allowing for shorter time to diagnosis and reduced delays in starting an adequate treatment regimen. MDR/XDR-TB treatment strategies are currently on an evolving stage...
February 20, 2018: Current Opinion in Pulmonary Medicine
Charles Feldman, Ronald Anderson
PURPOSE OF REVIEW: The manuscript reviews the recent literature describing the occurrence, risk factors, recognition and treatment of sepsis, respiratory failure, and multiple organ dysfunction in patients with community-acquired pneumonia (CAP). RECENT FINDINGS: CAP may present with varying degrees of disease severity ranging from an almost asymptomatic infection to a fulminant systemic disease with both respiratory failure and multiple organ dysfunction. Severe sepsis occurs early in the course of the infection in more than 30% of cases...
February 19, 2018: Current Opinion in Pulmonary Medicine
Otavio T Ranzani, Leandro Utino Taniguchi, Antoni Torres
PURPOSE OF REVIEW: To describe the current understanding and clinical applicability of severity scoring systems in pneumonia management. RECENT FINDINGS: Severity scores in community-acquired pneumonia are strong markers of mortality, but are not necessarily clinical decision-aid tools. The use of severity scores to support outpatient care in low-risk patients has moderate-to-strong evidence available in the literature, mainly for the pneumonia severity index, and must be applied together with clinical judgment...
February 8, 2018: Current Opinion in Pulmonary Medicine
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