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Journal of Thoracic Disease Dec 2015Laser photoresection of central airway obstruction is a useful tool for an Interventional Pulmonologist (IP). Endobronchial therapy of the malignant airway obstruction... (Review)
Review
Laser photoresection of central airway obstruction is a useful tool for an Interventional Pulmonologist (IP). Endobronchial therapy of the malignant airway obstruction is considered as a palliative measure or a bridge therapy to the definite treatment of cancer. Several ablative therapies such as electrocautery, argon plasma coagulation (APC), cryotherapy and laser photoresection exist in the armamentarium of IP to tackle such presentations. Besides Neodymium-Yttrium, Aluminum, Garnet (Nd:YAG) laser, there are several different types of laser that have been used by the pulmonologist with different coagulative and cutting properties. This chapter focuses on the historical perspective, current status, and potentials of lasers in the management of central airway lesions.
PubMed: 26807285
DOI: 10.3978/j.issn.2072-1439.2015.12.55 -
Lung India : Official Organ of Indian... 2016Endoscopic ultrasound (EUS) of the mediastinum was pioneered by gastroenterologists, and it was taken up by pulmonologists when the smaller-diameter endobronchial... (Review)
Review
Endoscopic ultrasound (EUS) of the mediastinum was pioneered by gastroenterologists, and it was taken up by pulmonologists when the smaller-diameter endobronchial ultrasound (EBUS) scope was designed after a few years. The pulmonologists' approach remained largely confined to entry from the trachea, but they soon realized that the esophagus was an alternative route of entry by the EBUS scope. The new generations of interventionists are facing the challenge of learning two techniques (EUS and EBUS) from two routes (esophagus and trachea). The International Association for the Study of Lung Cancer (IASLC) proposed a classification of mediastinal lymph nodes at different stations that lie within the boundaries of specific spaces. These interventionists need clear definitions of landmarks and clear techniques to identify the spaces. There are enough descriptions of spaces of the neck and the mediastinum in the literature, yet the topic mentioned above has never been discussed separately. The anatomical structures, landmarks, and boundaries of spaces will be important to interventionists in the near future during performances of endosonography. This article combines the baseline anatomy of the spaces with the actual imaging during EUS.
PubMed: 27185994
DOI: 10.4103/0970-2113.180866 -
European Respiratory Review : An... Sep 2022Single-cell ribonucleic acid sequencing is becoming widely employed to study biological processes at a novel resolution depth. The ability to analyse transcriptomes of... (Review)
Review
Single-cell ribonucleic acid sequencing is becoming widely employed to study biological processes at a novel resolution depth. The ability to analyse transcriptomes of multiple heterogeneous cell types in parallel is especially valuable for cell-focused lung research where a variety of resident and recruited cells are essential for maintaining organ functionality. We compared the single-cell transcriptomes from publicly available and unpublished datasets of the lungs in six different species: human (), African green monkey (), pig (), hamster (), rat () and mouse () by employing RNA velocity and intercellular communication based on ligand-receptor co-expression, among other techniques. Specifically, we demonstrated a workflow for interspecies data integration, applied a single unified gene nomenclature, performed cell-specific clustering and identified marker genes for each species. Overall, integrative approaches combining newly sequenced as well as publicly available datasets could help identify species-specific transcriptomic signatures in both healthy and diseased lung tissue and select appropriate models for future respiratory research.
Topics: Animals; Base Sequence; Chlorocebus aethiops; Cricetinae; Humans; Lung; Mice; Pulmonologists; Rats; Species Specificity; Swine; Transcriptome
PubMed: 35896273
DOI: 10.1183/16000617.0056-2022 -
European Respiratory Review : An... Dec 2020Monogenic type I interferonopathies are inherited heterogeneous disorders characterised by early onset of systemic and organ specific inflammation, associated with...
Monogenic type I interferonopathies are inherited heterogeneous disorders characterised by early onset of systemic and organ specific inflammation, associated with constitutive activation of type I interferons (IFNs). In the last few years, several clinical reports identified the lung as one of the key target organs of IFN-mediated inflammation. The major pulmonary patterns described comprise children's interstitial lung diseases (including diffuse alveolar haemorrhages) and pulmonary arterial hypertension but diagnosis may be challenging. Respiratory symptoms may be either mild or absent at disease onset and variably associated with systemic or organ specific inflammation. In addition, associated extrapulmonary clinical features may precede lung function impairment by years, and patients may display severe/endstage lung involvement, although this may be clinically hidden during the long-term disease course. Conversely, a few cases of atypical severe lung involvement at onset have been reported without clinically manifested extrapulmonary signs. Hence, a multidisciplinary approach involving pulmonologists, paediatricians and rheumatologists should always be considered when a monogenic interferonopathy is suspected. Pulmonologists should also be aware of the main pattern of presentation to allow prompt diagnosis and a targeted therapeutic strategy. In this regard, promising therapeutic strategies rely on Janus kinase-1/2 (JAK-1/2) inhibitors blocking the type I IFN-mediated intracellular cascade.
Topics: Child; Humans; Inflammation; Interferon Type I; Lung; Lung Diseases, Interstitial
PubMed: 33328278
DOI: 10.1183/16000617.0001-2020 -
Respirology (Carlton, Vic.) May 2019
Topics: Biopsy, Needle; Bronchoscopy; Electromagnetic Phenomena; Humans; Pulmonologists
PubMed: 30803118
DOI: 10.1111/resp.13508 -
Journal of Thoracic Disease Aug 2021Critical care ultrasound has shifted the paradigm of thoracic imaging by enabling the treating physician to acquire and interpret images essential for clinical... (Review)
Review
Critical care ultrasound has shifted the paradigm of thoracic imaging by enabling the treating physician to acquire and interpret images essential for clinical decision-making, at the bedside, in real-time. Once considered impossible, lung ultrasound based on interpretation of artifacts along with true images, has gained momentum during the last decade, as an integral part of rapid evaluation algorithms for acute respiratory failure, shock and cardiac arrest. Procedural ultrasound image guidance is a standard of care for both common bedside procedures, and advanced procedures within interventional pulmonologist's (IP's) scope of practice. From IP's perspective, the lung, pleural, and chest wall ultrasound expertise is a prerequisite for mastery in pleural drainage techniques and transthoracic biopsies. Another ultrasound application of interest to the IP in the intensive care unit (ICU) setting is during percutaneous dilatational tracheostomy (PDT). As ICU demographics shift towards older and sicker patients, the indications for closed pleural drainage procedures, bedside transthoracic biopsies, and percutaneous dilatational tracheostomies have dramatically increased. Although ultrasound expertise is considered an essential IP operator skill there is no validated curriculum developed to address this component. Further, there is a need for developing an educational tool that matches up with the curriculum and could be integrated real-time with ultrasound-guided procedures.
PubMed: 34527370
DOI: 10.21037/jtd-19-3564 -
Drugs & Aging May 2017Asthma has been demonstrated to be as common in the elderly as in younger age groups. Although no specific recommendations exist to manage the disease differently in... (Review)
Review
Asthma has been demonstrated to be as common in the elderly as in younger age groups. Although no specific recommendations exist to manage the disease differently in older individuals, functional features and clinical presentations may be affected by age per se, and by age-related conditions, such as comorbidities and polypharmacy. In this review article, we aimed to explore the efficacy and safety in elderly asthmatic patients of one of the most currently used inhaled treatments for asthma, that is, the fixed-dose combination of budesonide/formoterol. We attempted to address some practical questions that are relevant to the daily practice of clinicians. We focused on the efficacy and real-world effectiveness of inhaled corticosteroids and long-acting β-adrenergic bronchodilators (ICS/LABA) as treatment in the elderly population, since data are extrapolated from younger populations. We investigated whether a maintenance and reliever therapy approach is more effective in the elderly as opposed to maintenance regimens, from both the general practitioner's and the pulmonologist's perspective. To address these questions, we scanned electronic databases (PubMed, MEDLINE, Embase, Scopus and Google Scholar) from the date of inception up to October 2016 with a cross-search using the following keywords: 'asthma', 'elderly', 'SMART therapy', 'MART therapy', 'Turbuhaler', and 'budesonide/formoterol'. The available literature on the topic confirms that when the age-associated changes are properly managed in clinical practice, asthma in older populations can be optimally controlled with inhaled treatment including ICS/LABA. This also applies for the budesonide/formoterol fixed combination, thus allowing for the maintenance and reliever therapy approach.
Topics: Administration, Inhalation; Aged; Anti-Asthmatic Agents; Asthma; Budesonide, Formoterol Fumarate Drug Combination; Databases, Factual; Drug Interactions; Humans; Middle Aged; Practice Guidelines as Topic; Treatment Outcome
PubMed: 28258535
DOI: 10.1007/s40266-017-0449-7 -
Cureus Sep 2022Tracheobronchopathia Osteochondroplastica (TO) is an extremely rare condition characterized by the presence of nodules made of bone and cartilage within the submucosa of...
Tracheobronchopathia Osteochondroplastica (TO) is an extremely rare condition characterized by the presence of nodules made of bone and cartilage within the submucosa of the tracheobronchial wall. These protuberant nodules inside the trachea and bronchi can lead to airway obstruction, resulting in patients who experience recurrent respiratory systems and infections. The exact etiology is unknown. The mean age of diagnosis is in the 5th - 6th decades of life. TO is often confused with other diagnoses, especially asthma. We report a 41-year-old female who presented with intermittent exertional dyspnea for 10 years. Workups, including pulmonary function test, CT chest, and most importantly, flexible bronchoscopy, aided in the appropriate diagnosis. The unique feature observed during bronchoscopy is the sparing of the posterior wall of the trachea and bronchi.
PubMed: 36225397
DOI: 10.7759/cureus.28832 -
Clinical Issues for Pediatric Pulmonologists Managing Children With Thoracic Insufficiency Syndrome.Frontiers in Pediatrics 2020Thoracic insufficiency Syndrome (TIS) is a recently coined phrase to describe children with spine and chest wall deformities, inherited and acquired, who have... (Review)
Review
Thoracic insufficiency Syndrome (TIS) is a recently coined phrase to describe children with spine and chest wall deformities, inherited and acquired, who have respiratory impairment, and are skeletally immature. This population has both restrictive and less often obstructive lung disease due to changes in spine and rib configuration which reduce lung volume, stiffen the chest wall, and reduce respiratory muscle strength. Although the population is heterogeneous with regard to age of onset, etiology, severity of deformity, and rate of progression of the deformity, there are common issues that arise which can be addressed by pediatric pulmonologists. These are illustrated in this review by using Early Onset Scoliosis as a common form of TIS. The pulmonary issues pertaining to TIS require collaboration with multi-disciplinary teams, particularly spine surgeons, in order to make decisions about non-surgical and surgical strategies, timing of surgery and medical supportive care over time. Pulmonary input about respiratory function should be used in conjunction with structural features of each deformity in order to determine the impact of the deformity and the response to various treatment options. In those patients with residual lung function impairment as young adults, pediatric pulmonologists must also ensure successful transition to adult care.
PubMed: 32793525
DOI: 10.3389/fped.2020.00392 -
Cleveland Clinic Journal of Medicine May 2018Idiopathic pulmonary fibrosis (IPF) is a specific type of fibrosing interstitial pneumonia of unknown cause. It is usually chronic and progressive, tends to affect... (Review)
Review
Idiopathic pulmonary fibrosis (IPF) is a specific type of fibrosing interstitial pneumonia of unknown cause. It is usually chronic and progressive, tends to affect mainly adults over age 60, has a predilection for men, and is often fatal. The condition is still underappreciated by pulmonologists and primary care physicians. This article attempts to close that information gap by reviewing the natural course of IPF and presenting an algorithmic approach to diagnosis and treatment based on evidence-based international guidelines. New treatment options are briefly discussed, to raise awareness of new medications that target pulmonary fibrosis.
Topics: Aged; Female; Health Knowledge, Attitudes, Practice; Humans; Idiopathic Pulmonary Fibrosis; Male; Middle Aged; Physicians, Primary Care; Pulmonologists
PubMed: 29733782
DOI: 10.3949/ccjm.85a.17018