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European Respiratory Review : An... Sep 2021Tuberous sclerosis complex (TSC) is a rare multisystem genetic disorder affecting almost all organs with no sex predominance. TSC has an autosomal-dominant inheritance...
Tuberous sclerosis complex (TSC) is a rare multisystem genetic disorder affecting almost all organs with no sex predominance. TSC has an autosomal-dominant inheritance and is caused by a heterozygous mutation in either the or gene leading to hyperactivation of the mammalian target of rapamycin (mTOR). TSC is associated with several pulmonary manifestations including lymphangioleiomyomatosis (LAM), multifocal micronodular pneumocyte hyperplasia (MMPH) and chylous effusions. LAM is a multisystem disorder characterised by cystic destruction of lung parenchyma, and may occur in either the setting of TSC (TSC-LAM) or sporadically (S-LAM). LAM occurs in 30-40% of adult females with TSC at childbearing age and is considered a nonmalignant metastatic neoplasm of unknown origin. TSC-LAM is generally milder and, unlike S-LAM, may occur in males. It manifests as multiple, bilateral, diffuse and thin-walled cysts with normal intervening lung parenchyma on chest computed tomography. LAM is complicated by spontaneous pneumothoraces in up to 70% of patients, with a high recurrence rate. mTOR inhibitors are the treatment of choice for LAM with moderately impaired lung function or chylous effusion. MMPH, manifesting as multiple solid and ground-glass nodules on high-resolution computed tomography, is usually harmless with no need for treatment.
Topics: Adult; Female; Humans; Lung; Lung Neoplasms; Lymphangioleiomyomatosis; Male; Pulmonologists; Tuberous Sclerosis
PubMed: 34348978
DOI: 10.1183/16000617.0348-2020 -
Innovations (Philadelphia, Pa.) 2021
Topics: Bronchoscopy; Humans; Lung Neoplasms; Pulmonologists; Surgeons
PubMed: 33754842
DOI: 10.1177/1556984521997421 -
Advances in Respiratory Medicine Jan 2022Rapid on-site evaluation (ROSE) during transbronchial needle aspiration (TBNA) is conventionally performed by pathologists. However, availability of a pathologist in the...
INTRODUCTION
Rapid on-site evaluation (ROSE) during transbronchial needle aspiration (TBNA) is conventionally performed by pathologists. However, availability of a pathologist in the bronchoscopy suite is often an issue. We aimed to study if a pulmonologist, after receiving a short period of training in cytopathology, is able to assess the adequacy of onsite samples during TBNA.
MATERIAL AND METHODS
A pulmonologist was initially trained by a pathologist in examining cytology slides and assessing sample adequacy on TBNA smears. During TBNA, one slide from each needle pass was stained on-site using rapid Giemsa stain and was labelled as ROSE slide. The remaining slides were sent to the pathology laboratory for definitive cytological analysis. The ROSE slides were examined by a pulmonologist and a pathologist blinded to each other's interpretation. Level of agreement between the pulmonologist and pathologist was assessed by estimating Cohen's kappa.
RESULTS
A total of 172 slides from 35 patients were prepared for ROSE and evaluated independently by pulmonologist and pathologist. For adequacy, the pulmonologist and pathologist agreed in 143 out of the 172 slides (83% agreement), κ 0.649 (p < 0.001). For diagnostic categories, the pulmonologist and the pathologist agreed in 143 out of the 172 slides (83% agreement); κ 0.696 (p < 0.001). The sensitivity, specificity and accuracy of ROSE performed by the pulmonologist with respect to that performed by the pathologist was 66.2%, 96.8% and 83.1% respectively.
CONCLUSION
After a short period of training in cytopathology, a pulmonologist can assess for adequacy of TBNA ROSE slides in the bronchoscopy suite.
PubMed: 35099056
DOI: 10.5603/ARM.a2022.0020 -
The Lancet. Respiratory Medicine Apr 2021
Topics: COVID-19; Critical Care; Humans; Infectious Disease Transmission, Patient-to-Professional; Intensive Care Units; Leadership; Patient Care Team; Peer Group; Pulmonologists; Work-Life Balance; Workload
PubMed: 33581082
DOI: 10.1016/S2213-2600(21)00039-4 -
Current Medical Research and Opinion Aug 2022Cough is one of the most common health issues for which medical attention is sought. A chronic cough (CC) is understood as a cough that lasts longer than 8 weeks. CC...
BACKGROUND
Cough is one of the most common health issues for which medical attention is sought. A chronic cough (CC) is understood as a cough that lasts longer than 8 weeks. CC encompasses two subsets referred to as refractory chronic cough (RCC) and unexplained chronic cough (UCC). This study aims to assess the current understanding and perceptions of a RCC and UCC, from a physician's perspective in Switzerland and how this understanding and practical work leads to the relevant diagnosis and treatment.
METHODS
In October 2020, 549 GPs and 338 pulmonologists in Switzerland, received an invite to participate in the online-based quantitative survey. Data collection was carried out through a 25-minute online survey. The questionnaire was based on structured questions, and conducted on a randomized sample of doctors (general practitioners -GPs and pulmonologists) in the German- and French-speaking part of Switzerland.
RESULTS
Overall, 33 pulmonologists and 52 GPs participated in the online survey. Only 39% of GPs, but 73% of pulmonologists, defined chronic cough as a cough lasting 8 weeks or longer. The majority of physicians (72%), especially pulmonologists (88%), perceived a clinical gap regarding the treatment of persistent cough. 74% of the sampled physicians agreed that persistent cough is a high burden of disease for patients. Based on the answers, the annual number of new patients with RCC and UCC in Switzerland is estimated at 9322 patients.
CONCLUSIONS
Results of this study have highlighted differences in the terminology used to describe CC (RCC and UCC), in the diagnostic tests used and, in the treatments used between GPs and pulmonologists. These findings suggest the need to align the current language regarding the disease to facilitate a standardized approach for diagnosis and treatment and towards improving patient care and reduce burden of disease for CC (RCC and UCC) patients.
Topics: Carcinoma, Renal Cell; Chronic Disease; Cough; General Practitioners; Humans; Kidney Neoplasms; Perception; Surveys and Questionnaires; Switzerland
PubMed: 35369836
DOI: 10.1080/03007995.2022.2057154 -
Pulmonary Therapy Dec 2021Due to frequent lung involvement, the pulmonologist is often the reference physician for management of sarcoidosis, a systemic granulomatous disease with a heterogeneous... (Review)
Review
Due to frequent lung involvement, the pulmonologist is often the reference physician for management of sarcoidosis, a systemic granulomatous disease with a heterogeneous course. Treatment of sarcoidosis raises some issues. The first challenge is to select patients who are likely to benefit from treatment, as sarcoidosis may be self-limiting and remit spontaneously, in which case treatment can be postponed and possibly avoided without any significant impact on quality of life, organ damage or prognosis. Systemic glucocorticosteroids (GCs) are the drug of first choice for sarcoidosis. When GCs are started, there is a > 50% chance of long-term treatment. Prolonged use of prednisone at > 10 mg/day or equivalent is often associated with severe side effects. In these and refractory cases, steroid-sparing options are advised. Antimetabolites, such as methotrexate, are the second-choice therapy. Biologics, such as anti-TNF and especially infliximab, are third-choice drugs. The three treatments can be used concomitantly. Regardless of whether treatment is started, the clinician needs to organize regular follow-up to monitor remissions, flares, progression, complications, toxicity and relapses in order to promptly adjust the drugs used.
PubMed: 34143362
DOI: 10.1007/s41030-021-00160-x -
Respirology (Carlton, Vic.) Sep 2022Genetic analysis is emerging for interstitial lung diseases (ILDs); however, ILD practices are not yet standardized. We surveyed patients', relatives' and...
BACKGROUND AND OBJECTIVE
Genetic analysis is emerging for interstitial lung diseases (ILDs); however, ILD practices are not yet standardized. We surveyed patients', relatives' and pulmonologists' experiences and needs on genetic testing in ILD to evaluate the current situation and identify future needs.
METHODS
A clinical epidemiologist (MT) together with members of the ERS taskforce and representatives of the European Idiopathic Pulmonary Fibrosis and related disorders Federation (EU-IPFF) patient organisation developed a survey for patients, relatives and pulmonologists. Online surveys consisted of questions on five main topics: awareness of hereditary ILD, the provision of information, genetic testing, screening of asymptomatic relatives and clinical impact of genetic analysis in ILD.
RESULTS
Survey respondents consisted of 458 patients with ILD, 181 patients' relatives and 352 pulmonologists. Most respondents think genetic testing can be useful, particularly for explaining the cause of disease, predicting its course, determining risk for developing disease and the need to test relatives. Informing patients and relatives on genetic analysis is primarily performed by the pulmonologist, but 88% (218) of pulmonologists identify a need for more information and 96% (240) ask for guidelines on genetic testing in ILD. A third of the pulmonologists who would offer genetic testing currently do not offer a genetic test, primarily because they have limited access to genetic tests. Following genetic testing, 72% (171) of pulmonologists may change the diagnostic work-up and 57% (137) may change the therapeutic approach.
CONCLUSION
This survey shows that there is wide support for implementation of genetic testing in ILD and a high need for information, guidelines and access to testing among patients, their relatives and pulmonologists.
Topics: Genetic Testing; Humans; Idiopathic Pulmonary Fibrosis; Lung Diseases, Interstitial; Pulmonologists; Surveys and Questionnaires
PubMed: 35652243
DOI: 10.1111/resp.14303 -
The Journal of Nutrition, Health & Aging 2022The present study aimed to investigate the incidence of and risk factors for postoperative pneumonia and aspiration pneumonia after hip fracture surgery.
OBJECTIVES
The present study aimed to investigate the incidence of and risk factors for postoperative pneumonia and aspiration pneumonia after hip fracture surgery.
DESIGN
Retrospective cohort study from 2005 to 2021.
SETTING
Asan Medical Center in Seoul, Republic of Korea.
PARTICIPANTS
A total 1,208 patients aged ≥ 65 years who underwent hip fracture surgery.
MEASUREMENTS
Postoperative pneumonia was defined as cases with new infiltration on chest x-ray or chest computed tomography (CT) after surgery or confirmed by a pulmonologist's consultation and diagnosis. Aspiration pneumonia was defined as: 1) radiologic findings of hospital-acquired pneumonia on chest radiographs or CT, medical record of aspiration pneumonia confirmed by a pulmonologist's consultation, and history of vomiting or aspiration, or 2) gravity-dependent opacity on chest CT when the history of vomiting or aspiration is ambiguous. Patient demographics, past medical history, pre-injury Koval score, Charlson Comorbidity Index (CCI), blood test results, length of hospital stay, and in-hospital mortality were evaluated. A comparison analysis and binary logistic regression were performed to identify the incidence and risk factors for postoperative pneumonia and aspiration pneumonia.
RESULTS
Postoperative pneumonia was diagnosed in 47 patients (3.9%), including 20 with aspiration pneumonia (1.7%). In the multivariate analysis, postoperative delirium (odds ratio [OR], 3.42; P < 0.001), American Society of Anesthesiologists (ASA) scores ≥ 3 (OR, 2.11; P = 0.021), and CCI (OR, 1.21; P = 0.013) were significant risk factors for postoperative pneumonia. Male sex (OR, 3.01; P = 0.017), postoperative delirium (OR, 3.16; P = 0.014), and preoperative serum albumin levels < 3.5 g/dL (OR, 7.00; P = 0.010) were significant risk factors for aspiration pneumonia.
CONCLUSION
ASA classification ≥ 3, higher CCI, and postoperative delirium were the risk factors for postoperative pneumonia. Male sex, postoperative delirium, and lower preoperative serum albumin level were the risk factors for aspiration pneumonia. Thus, physicians should pay attention to patients with the risk factors.
Topics: Aged; Delirium; Hip Fractures; Humans; Male; Pneumonia; Pneumonia, Aspiration; Postoperative Complications; Retrospective Studies; Risk Factors; Serum Albumin; Vomiting
PubMed: 35842764
DOI: 10.1007/s12603-022-1821-9 -
Der Internist Jul 2015The best strategy for prevention of acute respiratory tract infections is primary prophylaxis against diseases preventable by vaccination. From the pulmonologist's point... (Review)
Review
BACKGROUND
The best strategy for prevention of acute respiratory tract infections is primary prophylaxis against diseases preventable by vaccination. From the pulmonologist's point of view, vaccinations against pneumococci, influenza A and B viruses and Bordetella pertussis are of particular clinical relevance.
OBJECTIVES
This review article discusses the disease burden of these pathogens and the recommendations for immunization in adults.
CURRENT DATA
For immunization against pneumococci a less immunogenic but broad-spectrum 23-valent polysaccharide vaccine (PPV23) and a highly immunogenic 13-valent conjugate vaccine (PCV13) with a more narrow-spectrum are approved. A sequential vaccination with PCV13 followed by PPV23 is a new option in adults. In the US this vaccination strategy is recommended as routine vaccination for all adults over 65. In Germany sequential pneumococcal vaccination is proposed only in special indications such as patients with asplenia. Trivalent and quadrivalent split-virus vaccines are the standard vaccines against seasonal influenza in adults. The Standing Committee on Vaccinations (STIKO) recommends a yearly vaccination as standard over 60 and in indications for special risk groups (e.g. infants with underlying diseases, immunocompromised patients, chronically ill patients and pregnant women). For the primary prophylaxis of pertussis only an acellular vaccine is available. Neither vaccination nor a previous infection provide lifelong immunity; therefore, the STIKO recommends an additional booster vaccine for all adults.
CONCLUSION
Vaccination against pneumococci, influenza A and B viruses as well as Bordetella pertussis are recommended as standard and in special indications for adults by the STIKO at the Robert Koch Institute. For selection of the various vaccines individual factors such as age, immune status, comorbidities and pregnancy have to be considered.
Topics: Drug Administration Schedule; Evidence-Based Medicine; Humans; Influenza Vaccines; Influenza, Human; Mass Vaccination; Pertussis Vaccine; Pneumococcal Vaccines; Pneumonia, Pneumococcal; Treatment Outcome; Whooping Cough
PubMed: 26059891
DOI: 10.1007/s00108-015-3734-8 -
Journal of Thoracic Disease Sep 2023Lung transplantation (LTx) in Japan has taken steps toward increasing the number of donors and recipients and is at the maturity stage of development, at which point... (Review)
Review
BACKGROUND AND OBJECTIVE
Lung transplantation (LTx) in Japan has taken steps toward increasing the number of donors and recipients and is at the maturity stage of development, at which point pulmonologists (hereinafter referred to as "respirologists") become involved in transplant practice. Because of severe donor shortage and limited number of LTx surgeries, most of transplant process from candidacy evaluation to post-operative management has been handled only by thoracic surgeons, which takes away opportunities from respirologists to manage LTx recipients. Given the growth of both LTx and the number of patients with complex problems, cooperation with respirologists in transplant practice is urgently needed to achieve transplant success in Japan.
METHODS
Authors summarized current transplant circumstance in Japan from the transplant physician's standpoint. A systematic search through PubMed database and Google Scholar was performed by terms of "respirologists", "pulmonologist", "lung transplant" or "Japan" from 2000 and 2022. Thoracic surgeons working at each transplant center were asked to complete a questionnaire on physicians' intervention to LTx.
KEY CONTENT AND FINDINGS
The roles of respirologists in LTx differ with facility size and function, depending on whether they are working at a non-transplant center with other respirologists or at a transplant center with transplant physicians. LTx centers are currently devoted to educating respirologists who work at non-transplant or low-volume transplant centers in order for them to deal with patients before and after transplantation.
CONCLUSIONS
Joint efforts and training of outstanding personnel who can take care of recipients are required, this being the greatest issue for the success of transplantation in Japan.
PubMed: 37868896
DOI: 10.21037/jtd-22-1716