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Archivos de Bronconeumologia Jul 2019
Topics: Home Care Services; Home Nursing; Humans; Idiopathic Pulmonary Fibrosis; Interdisciplinary Communication; Life Expectancy; Noninvasive Ventilation; Palliative Care; Patient Care Team; Physician's Role; Practice Guidelines as Topic; Pulmonary Disease, Chronic Obstructive; Pulmonologists; Terminal Care
PubMed: 30606632
DOI: 10.1016/j.arbres.2018.11.016 -
Jornal Brasileiro de Pneumologia :... 2022Many health systems have been using coronary CT angiography (CCTA) as a first-line examination for ischaemic heart disease patients in various countries. The rising... (Review)
Review
Many health systems have been using coronary CT angiography (CCTA) as a first-line examination for ischaemic heart disease patients in various countries. The rising number of CCTA examinations has led to a significant increase in the number of reported incidental extracardiac findings, mainly in the chest. Pulmonary nodules are the most common incidental findings on CCTA scans, as there is a substantial overlap of risk factors between the population seeking to exclude ischaemic heart disease and those at risk of developing lung cancer (i.e., advanced age and smoking habits). However, most incidental findings are clinically insignificant and actively pursuing them could be cost-prohibitive and submit the patient to unnecessary and potentially harmful examinations. Furthermore, there is little consensus regarding when to report or actively exclude these findings and how to manage them, that is, when to trigger an alert or to immediately refer the patient to a pulmonologist, a thoracic surgeon or a multidisciplinary team. This pictorial essay discusses the current literature on this topic and is illustrated with a review of CCTA scans. We also propose a checklist organised by organ and system, recommending actions to raise awareness of pulmonologists, thoracic surgeons, cardiologists and radiologists regarding the most significant and actionable incidental findings on CCTA scans.
Topics: Computed Tomography Angiography; Coronary Angiography; Coronary Artery Disease; Humans; Incidental Findings; Tomography, X-Ray Computed
PubMed: 35584528
DOI: 10.36416/1806-3756/e20220015 -
Advances in Respiratory Medicine Jan 2023Bronchoscopy and endobronchial ultrasound (EBUS) are standard procedures for the diagnosis and staging of patients suspected of lung cancer. If the patient...
BACKGROUND
Bronchoscopy and endobronchial ultrasound (EBUS) are standard procedures for the diagnosis and staging of patients suspected of lung cancer. If the patient simultaneously presents with suspicious liver lesions, it is tradition to refer the patient to a radiologist for ultrasound-guided percutaneous liver biopsy.
OBJECTIVE
The aim of this study was to investigate the results and complications when the pulmonologist performs all three procedures in the same setting.
METHODS
We retrospectively identified patients who during 2018-2020 underwent invasive workup of suspected lung cancer and liver metastases with percutaneous liver lesion biopsy with or without same-day endoscopy (bronchoscopy and EBUS). We compared diagnostic yield and safety of liver lesion biopsy stratified by same-day endoscopy or not.
RESULTS
In total, 89 patients were included, of whom 28 patients (31%) underwent same-day endoscopy. All liver lesion biopsies were fine-needle aspiration biopsies performed by experienced pulmonologists. No complications were reported, and overall diagnostic yield was 88%. The diagnostic yield was significantly lower in the same-day endoscopy group (71% vs. 95%), and undergoing endoscopy was significantly associated with having fewer liver lesions, higher prevalence of lung cancer, and lower overall prevalence of a malignant diagnosis.
CONCLUSION
Liver biopsy in the same session as endoscopy during lung cancer workup was feasible and safe. Confounding by indication was present in our study.
Topics: Humans; Bronchoscopy; Pulmonologists; Retrospective Studies; Lung Neoplasms; Biopsy, Fine-Needle
PubMed: 36825937
DOI: 10.3390/arm91010003 -
Respiratory Medicine 2021Hematopoietic stem cell transplantation (HSCT) is used for treatment of a myriad of both malignant and non-malignant disorders. However, despite many advances over the... (Review)
Review
Hematopoietic stem cell transplantation (HSCT) is used for treatment of a myriad of both malignant and non-malignant disorders. However, despite many advances over the years which have resulted in improved patient mortality, this subset of patients remains at risk for a variety of post-transplant complications. Pulmonary complications of HSCT are categorized into infectious and non-infectious and occur in up to one-third of patients undergoing HSCT. Infectious etiologies include bacterial, viral and fungal infections, each of which can have significant mortality if not identified and treated early in the course of infection. Advances in the diagnosis and management of infectious complications highlight the importance of non-infectious pulmonary complications related to chemoradiation toxicities, immunosuppressive drugs toxicities, and graft-versus-host disease. This report aims to serve as a guide and clinical update of pulmonary complications following HSCT for the general pulmonologist who may be involved in the care of these patients.
Topics: Clinical Competence; Female; Health Knowledge, Attitudes, Practice; Hematopoietic Stem Cell Transplantation; Humans; Infection Control; Infections; Male; Patient Care; Postoperative Complications; Pulmonologists; Risk
PubMed: 34107323
DOI: 10.1016/j.rmed.2021.106493 -
Pneumologie (Stuttgart, Germany) Aug 2016In general chronic obstructive pulmonary disease (COPD) can be diagnosed in family practice from history and spirometry. Inconclusive spirometry findings have to be... (Review)
Review
In general chronic obstructive pulmonary disease (COPD) can be diagnosed in family practice from history and spirometry. Inconclusive spirometry findings have to be assessed further by techniques available in a pulmonologist's office. Further testing is done for differential diagnostic reasons and for prognostic appraisal. Successful smoking cessation importantly alters the natural downhill course of the disease. Patient education and rehabilitative interventions (e. g. participation in lung sport groups) help to improve life quality. Medical therapies with bronchospasmolytics applied by inhalation as monotherapies, free and fixed combinations have symptomatic benefit. Considering the increase of pneumonia risk from inhaled corticosteroids their use should be restricted to patients with a straightforward indication, e. g. coexisting asthma.
Topics: Bronchodilator Agents; Combined Modality Therapy; Diagnosis, Differential; Diagnostic Imaging; Evidence-Based Medicine; Exercise Therapy; Humans; Patient Education as Topic; Pulmonary Disease, Chronic Obstructive; Respiratory Function Tests; Smoking Cessation; Sympathomimetics; Treatment Outcome
PubMed: 27512933
DOI: 10.1055/s-0042-109997 -
Respiration; International Review of... 2019The widespread use of rapid on-site evaluation is hampered by constraints related to time and resources, inadequate reimbursement, and evidence from randomized trials... (Clinical Trial)
Clinical Trial
BACKGROUND
The widespread use of rapid on-site evaluation is hampered by constraints related to time and resources, inadequate reimbursement, and evidence from randomized trials that show a lack of increase in diagnostic yield and specimen adequacy associated with its usage.
OBJECTIVE
We aimed to verify whether a pulmonologist can assess endosonography-derived lymph node samples after a comprehensive and reproducible training provided by a specialist pathologist.
METHODS
Prospective, observational trial structured in three phases. In the first (training) phase, a pathologist critically evaluated the smears from 150 archival endosonography cases with a pulmonologist. In the second (test) phase, the pulmonologist was asked to assess 50 archival endosonography-derived samples. In the last (real-life) phase, the pulmonologist classified the samples from 200 patients during the endosonography. The overall agreement between pulmonologist and pathologist (gold standard), assessed through κ-statistics, was the primary outcome. The agreement for the identification of specific cytological categories was the secondary outcome.
RESULTS
The overallagreement between pulmonologist and pathologist was 84% (κ0.765, 95% CI 0.732-0.826) in the test phase and 89.7% (κ 0.844, 95% CI 0.799-0.881) in the real-life phase. The agreement for specific cytological categories was 92.7% (95% CI 0.824-0.980) for inadequate samples, 90.3% (95% CI 84.5-94.5%) for reactive lymphadenopathies, 90.5% (95% CI 0.845-0.946) for malignancy, and 73% (95% CI 0.515-0.897) for granulomatous samples.
CONCLUSIONS
A trained pulmonologist can reliably assess adequacy and malignancy for endosonography-derived samples, which could be useful in institutions where a cytopathologist/cytotechnician is not available regularly.
Topics: Aged; Clinical Competence; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Endosonography; Female; Humans; Lymph Nodes; Male; Middle Aged; Observer Variation; Pulmonary Medicine; Reproducibility of Results
PubMed: 30982053
DOI: 10.1159/000496549 -
Vnitrni Lekarstvi 2021Systemic rheumatoid diseases form a large group of entities with variable clinical picture and different involvement and degree of organ impairment. Respiratory tract...
Systemic rheumatoid diseases form a large group of entities with variable clinical picture and different involvement and degree of organ impairment. Respiratory tract represents major site of damage, with lung interstitium, pleura, pulmonary vasculature and airways possibly affected. In systemic sclerodermia and rheumatoid arthritis, lung disease is the most significant cause of morbidity and mortality. Breathing difficulties may either present as first symptoms of underlying rheumatoid disease or may appear at any time during the course of the disease. Rheumatologists should routinely screen their patients for possible lung impairment. Similarly, extrapulmonal signs should be assessed by pulmonologists in patients referred for dyspnea. Currently, novel antifibrotic therapy is available not only for patients with idiopathic pulmonary fibrosis (IPF), but also for selected group of patients with non-IPF progressive fenotype associated interstitial lung disease having solid evidence-based background. Interdisciplinary approach in terms of collaboration between pulmonologist and rheumatologist is of key importance as proper identification of possible candidates and early onset of therapy is crucial.
Topics: Humans; Idiopathic Pulmonary Fibrosis; Indoles; Lung Diseases, Interstitial; Rheumatic Diseases
PubMed: 35459374
DOI: No ID Found -
Thorax Apr 2024Significant inconsistencies in respiratory care provision for Duchenne muscular dystrophy (DMD) are reported across different specialist neuromuscular centres in the UK.... (Review)
Review
UNLABELLED
Significant inconsistencies in respiratory care provision for Duchenne muscular dystrophy (DMD) are reported across different specialist neuromuscular centres in the UK. The absence of robust clinical evidence and expert consensus is a barrier to the implementation of care recommendations in public healthcare systems as is the need to increase awareness of key aspects of care for those living with DMD. Here, we provide evidenced-based and/or consensus-based best practice for the respiratory care of children and adults living with DMD in the UK, both as part of routine care and in an emergency.
METHODOLOGY
Initiated by an expert working group of UK-based respiratory physicians (including British Thoracic Society (BTS) representatives), neuromuscular clinicians, physiotherapist and patient representatives, draft guidelines were created based on published evidence, current practice and expert opinion. After wider consultation with UK respiratory teams and neuromuscular services, consensus was achieved on these best practice recommendations for respiratory care in DMD.
RESULT
The resulting recommendations are presented in the form of a flow chart for assessment and monitoring, with additional guidance and a separate chart setting out key considerations for emergency management. The recommendations have been endorsed by the BTS.
CONCLUSIONS
These guidelines provide practical, reasoned recommendations for all those managing day-to-day and acute respiratory care in children and adults with DMD. The hope is that this will support patients and healthcare professionals in accessing high standards of care across the UK.
Topics: Child; Adult; Humans; Muscular Dystrophy, Duchenne; Health Personnel; Pulmonologists; United Kingdom
PubMed: 38123347
DOI: 10.1136/thorax-2023-220811 -
North Carolina Medical Journal 2019In response to the National Lung Screening Trial, numerous professional organizations published guidelines recommending annual lung cancer screening with low-dose...
In response to the National Lung Screening Trial, numerous professional organizations published guidelines recommending annual lung cancer screening with low-dose computed tomography (LDCT) for high-risk patients. Prior studies found that physician attitudes and knowledge about lung cancer screening directly impacts the number of screening exams ordered. In 2015, we surveyed 34 pulmonologists and 186 primary care providers (PCPs) to evaluate opinions and practices of lung cancer screening in a large academic medical center. We compared PCP and pulmonologist responses using t-tests and χ tests. The overall survey response rate was 40% (39% for PCPs and 50% for pulmonologists). Pulmonologists were more likely than PCPs to report lung cancer screening as beneficial for patients (88.2% versus 37.7%, < .0001) and as being cost-effective (47.1% versus 14.3%, = .02). More pulmonologists (76%) reported ordering a LDCT for screening in the past 12 months compared to PCPs (41%, = .012). Pulmonologists and PCPs reported similar barriers to referring patients for lung cancer screening, including patient costs (82.4% versus 77.8%), potential for emotional harm (58.8% versus 58.3%), high false positive rate (47.1% versus 69.4%), and likelihood for medical complications (47.1% versus 59.7%). Our results are generalizable to academic medical centers and responses may be susceptible to recall bias, non-response bias, and social desirability bias. We found significant differences in opinions and practices between PCPs and pulmonologists regarding lung cancer screening referrals and perceived benefits. As lung cancer screening continues to emerge in clinical practice, it is important to understand these differences across provider specialty to ensure screening is implemented and offered to patients appropriately.
Topics: Academic Medical Centers; Adult; Attitude of Health Personnel; Early Detection of Cancer; Female; Humans; Lung Neoplasms; Male; Middle Aged; Physicians, Primary Care; Practice Patterns, Physicians'; Pulmonologists; Referral and Consultation; Tomography, X-Ray Computed; United States
PubMed: 30622199
DOI: 10.18043/ncm.80.1.19 -
Mucoactive and antioxidant medicines for COPD: consensus of a group of Chinese pulmonary physicians.International Journal of Chronic... 2017Airway mucus hypersecretion is a frequent symptom associated with acute and chronic airway disease. Inhibition of mucus production or promotion of mucolysis not only... (Review)
Review
Airway mucus hypersecretion is a frequent symptom associated with acute and chronic airway disease. Inhibition of mucus production or promotion of mucolysis not only relieved symptoms but also improved disease outcomes. There are numerous available mucoactive medicines for prescription, and how to select them properly for different diseases is important for clinical practice. So far, there is no one consensus or guideline reported. A group of Chinese pulmonary physicians worked together to complete this consensus based on literature review, summarized mechanism and usage of each classical mucoactive medicine. In general, antioxidant mucoactive medicines play an important role in chronic airway disease, including but not limited to airway mucus clearance, reduced acute exacerbation and improved pulmonary function.
Topics: Antioxidants; China; Consensus; Disease Progression; Expectorants; Humans; Lung; Mucociliary Clearance; Mucus; Pulmonary Disease, Chronic Obstructive; Pulmonologists; Quality of Life; Recovery of Function; Treatment Outcome
PubMed: 28405161
DOI: 10.2147/COPD.S114423