-
Journal of Thoracic Disease Sep 2013Endobronchial tumors are a rare entity that presents with different pathological findings. The interventional pulmonologist, but also the thoracic surgeon have at their... (Review)
Review
Endobronchial tumors are a rare entity that presents with different pathological findings. The interventional pulmonologist, but also the thoracic surgeon have at their disposal the same techniques for diagnosis, however; the two modalities differentiate in the treatment approach. Diagnosis evaluation should include lymph node evaluation. Minimal invasive techniques under local or general anesthesia are usually preferred by the interventional pulmonologists, whereas in the surgical approach of the thoracic surgeons the general anesthesia is necessary. A more extensive surgical approach either lobotomy or pneumonectomy should be performed in cases with positive intrapulmonary lymph nodes. Carinal reconstruction should be performed skillfully to get a negative proximal margin whenever needed. In the current manuscript we will present the methods of patient evaluation and surgical techniques for the management of these lesions.
PubMed: 24102010
DOI: 10.3978/j.issn.2072-1439.2013.06.22 -
Respiratory Care Jul 2018COPD guidelines advise on inhaled medication use, yet no advice is offered on when to use and which type of patient could benefit from a specific delivery device. We...
BACKGROUND
COPD guidelines advise on inhaled medication use, yet no advice is offered on when to use and which type of patient could benefit from a specific delivery device. We investigated pulmonologists' perception of their knowledge and practices with delivery devices for COPD management.
METHODS
An online survey was designed by a steering committee of American Thoracic Society clinicians and scientists and conducted by a national market research firm between January 7 and 29, 2016.
RESULTS
Two hundred and five respondents completed the survey. Nearly 80% of the respondents believed that they were very knowledgeable in COPD management and the use of medications; 68% believed that they were knowledgeable about preventing exacerbations. Ninety-eight percent of the respondents stated that they were at least somewhat knowledgeable about devices. Many respondents (70%) stated that small-volume nebulizers were more effective than dry powder inhalers and pressurized metered-dose inhalers in the management of COPD exacerbations, and 63% believed that these were more effective in severe COPD (modified Medical Research Council dyspnea scale grade 4). Only 54% of the respondents discussed device options with their patients. Physician screening for physical or cognitive impairments that could impact device choices was 53% and 16%, respectively. Seventy percent of the respondents discussed device use, whereas 9% discussed cleaning and storage during a patient's first visit. Few respondents were very knowledgeable in teaching patients how to use devices (43%) and, specifically, how to use (32%) or clean and/or maintain (20%) small-volume nebulizers.
CONCLUSIONS
Most respondents were confident in their knowledge about treating COPD. Fewer respondents were confident about the use and maintenance of inhalation devices, and most respondents desired to learn more about inhalation devices.
Topics: Adult; Female; Health Knowledge, Attitudes, Practice; Health Surveys; Humans; Male; Middle Aged; Nebulizers and Vaporizers; Pulmonary Disease, Chronic Obstructive; Pulmonologists; Respiratory Therapy
PubMed: 29717099
DOI: 10.4187/respcare.05717 -
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 -
Studies in Health Technology and... 2014Taking and interpreting spirometry tests has proven difficult in primary care practice. This may lead to mis- or underdiagnosis of pulmonary diseases, among others...
Taking and interpreting spirometry tests has proven difficult in primary care practice. This may lead to mis- or underdiagnosis of pulmonary diseases, among others chronic obstructive pulmonary disease. Telespirometry and telepulmonology consultation (TPC) may play a role in monitoring and improving the quality of the spirometry tests, supporting GPs in interpreting spirometry test results and reducing the number of physical referrals to the pulmonologist. In telespirometry up to 10% of spirometry results uploaded by GPs were randomly sent to a pulmonologist. Both the GP or practice nurse and the pulmonologist interpreted the spirometry results and gave their diagnostic findings. Additionally the pulmonologist assessed the quality of the test. In TPC a GP could digitally consult a pulmonologist for advice or referral of patients. On sending and closing the TPC consult the GP was presented a number of questions. Based on these questions the percentage of prevented physical referrals and the educational effect experienced by the GPs were determined. Almost a third of the 227 telespirometry tests was of Moderate or Bad quality. The Kappa of the interobserver agreement on diagnostic findings between GP and pulmonologist was 0.38. Between April 2009 and January 2014, GPS sent 4.488 TPCs to pulmonologists. Sixty-nine percent of the TPCs were sent to gain advice, the others were sent in order to prevent a physical referral. Overall telepulmonology reduced the number of physical referrals by 22%. In 90% of the TPCs the GPs indicated they had learned from the consult.
Topics: Clinical Competence; General Practice; Humans; Netherlands; Pulmonary Disease, Chronic Obstructive; Pulmonary Medicine; Remote Consultation; Reproducibility of Results; Sensitivity and Specificity; Spirometry
PubMed: 25160176
DOI: No ID Found -
The Journal of International Medical... Feb 2021To evaluate the efficacy of rapid on-site cytological evaluation (ROSE) in determining specimen adequacy and diagnostic accuracy in the interventional diagnosis of lung... (Comparative Study)
Comparative Study
Efficacy of rapid on-site cytological evaluation (ROSE) by a pulmonologist in determining specimen adequacy and diagnostic accuracy in interventional diagnosis of lung lesions.
OBJECTIVE
To evaluate the efficacy of rapid on-site cytological evaluation (ROSE) in determining specimen adequacy and diagnostic accuracy in the interventional diagnosis of lung lesions.
METHODS
This retrospective study included 127 consecutive cases of lung lesions, which were sampled by bronchoscopy or transthoracic fine needle aspiration, and diagnosed on ROSE followed by histopathology. ROSE was performed by a trained pulmonologist and the diagnosis of ROSE was compared with the final diagnosis.
RESULTS
The sensitivity of ROSE in determining adequacy of specimens was 97.5% and specificity in determining inadequacy was 85.7%. The diagnostic efficacy of ROSE for assessing malignancy (sensitivity of 94.5% and specificity of 100%) and non-malignancy (sensitivity of 97.8% and specificity of 100%) was excellent. The sensitivity of ROSE for diagnosing small cell carcinoma (100%) was highest, followed by adenocarcinoma (89.2%) and squamous cell carcinoma (75.0%). Performance of ROSE by a trained pulmonologist also determined tuberculosis with a high diagnostic sensitivity (83.3%) and specificity (100%).
CONCLUSIONS
A trained pulmonologist can reliably carry out ROSE to ensure the adequacy of the sample, distinguish between malignancy and non-malignancy, and make a preliminary diagnosis in a large number of cases.
Topics: Adenocarcinoma; Adult; Aged; Biopsy, Fine-Needle; Bronchoscopy; Carcinoma, Squamous Cell; Diagnosis, Differential; Female; Histological Techniques; Humans; Lung; Lung Neoplasms; Male; Middle Aged; Pneumonectomy; Pulmonologists; Retrospective Studies; Sensitivity and Specificity; Small Cell Lung Carcinoma
PubMed: 33527860
DOI: 10.1177/0300060520982687 -
Indian Pediatrics Mar 2020
Topics: Asthma; Bronchiolitis; Bronchiolitis, Viral; Child; Humans; Infant; Pulmonologists; Saline Solution
PubMed: 32198867
DOI: No ID Found -
The Journal of Allergy and Clinical... Mar 2021Pharmacotherapy is key in asthma control, including preventing lung function decline, in primary care. However, patients' physical functioning (eg, physical capacity...
BACKGROUND
Pharmacotherapy is key in asthma control, including preventing lung function decline, in primary care. However, patients' physical functioning (eg, physical capacity [PC] [=can do] and physical activity [PA] [=do do]) correlates poorly with lung function. Therefore, a better insight into the physical function of patients with asthma is needed, using the "can do, do do" concept.
OBJECTIVE
To explore the "can do, do do" concept in adult patients with asthma at referral for the first time to an outpatient consultation of a pulmonologist.
METHODS
PC was measured using the six-minute walk test and PA by using an accelerometer. Patients were classified into quadrants: low PC (6-minute walking distance <70% predicted), low PA (<7000 steps/d, "'can't do, don't do"); preserved PC, low PA ("can do, don't do"); low PC, preserved PA ("'can't do, do do"); or preserved PC, preserved PA ("can do, do do").
RESULTS
A total of 479 patients with asthma had a median (interquartile range) 6-minute walking distance of 74% (66%-82%) predicted, and walked 6829 (4593-9075) steps/d. Only 29% were classified as "can do, do do," whereas 30% were classified as "can't do, don't do." The Asthma Control Questionnaire and the Asthma Quality of Life Questionnaire scores were worst in the "can't do" groups.
CONCLUSIONS
Low PC and/or PA was found in most patients with asthma at the index referral to a pulmonologist. An impaired PC is accompanied by a significantly reduced asthma control and disease-specific quality of life. This justifies further studies on safety and efficacy of nonpharmacological interventions, such as physiotherapy.
Topics: Adult; Asthma; Humans; Pulmonologists; Quality of Life; Referral and Consultation; Walking
PubMed: 33097458
DOI: 10.1016/j.jaip.2020.09.049 -
Seminars in Respiratory and Critical... Aug 2022Malignant central airway obstruction (MCAO) is a debilitating and life-limiting complication that occurs in an unfortunately large number of individuals with advanced...
Malignant central airway obstruction (MCAO) is a debilitating and life-limiting complication that occurs in an unfortunately large number of individuals with advanced intrathoracic cancer. Although the management of MCAO is multimodal and interdisciplinary, the task of providing patients with prompt palliation falls increasingly on the shoulders of interventional pulmonologists. While a variety of tools and techniques are available for the management of malignant obstructive lesions, advancements and evolution in this therapeutic venue have been somewhat sluggish and limited when compared with other branches of interventional pulmonary medicine (e.g., the early diagnosis of peripheral lung nodules). Indeed, one pragmatic, albeit somewhat uncharitable, reading of this article's title might suggest a wry smile and shug of the shoulders as to imply that relatively little has changed in recent years. That said, the spectrum of interventions for MCAO continues to expand, even if at a less impressive clip. Herein, we present on MCAO and its endoscopic and nonendoscopic management-that which is old, that which is new, and that which is still on the horizon.
Topics: Airway Obstruction; Bronchoscopy; Humans; Lung Neoplasms; Pulmonary Medicine; Pulmonologists
PubMed: 35654419
DOI: 10.1055/s-0042-1748187 -
Cancer Cytopathology Apr 2016Rapid onsite evaluation (ROSE) has several potential benefits but also can prolong procedures if one must wait for a cytopathologist, and it can involve a considerable... (Comparative Study)
Comparative Study
BACKGROUND
Rapid onsite evaluation (ROSE) has several potential benefits but also can prolong procedures if one must wait for a cytopathologist, and it can involve a considerable time commitment on the part of the cytopathologist. At the University of Arkansas for Medical Sciences, interventional pulmonologists have routinely reviewed cytology specimens. This study was performed to determine prospectively how accurately pulmonologists could perform ROSE and whether they could contribute to the efficiency of the process.
METHODS
For sequential cases, the procedural pulmonologist documented a ROSE reading before the reading by the cytopathologist. Readings were compared between the two for agreement and for accuracy. The time commitment for the cytopathologist was also recorded.
RESULTS
One hundred sixty-four sites were biopsied in 102 patients. With respect to onsite adequacy, there was a high level of concordance between pulmonology and cytopathology as evidenced by the κ score ( ± standard error) of 0.72 ± 0.15 and by disagreement in only 3 cases (2%). For the diagnostic category, there was once again a high level of concordance; there was agreement in 141 of the 164 cases (86%), and the weighted κ score was 0.89 ± 0.02. The cytopathologist's time in the endoscopy suite averaged 4.02 ± 6.9 minutes per procedure.
CONCLUSIONS
Procedural pulmonologists can effectively learn enough cytology to be able to make ROSE a collaborative process and to greatly increase the efficiency of the cytopathologist.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biopsy, Fine-Needle; Cohort Studies; Cost Savings; Cost-Benefit Analysis; Cytodiagnosis; Female; Humans; Immunohistochemistry; Lung Neoplasms; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Point-of-Care Testing; Prospective Studies; Pulmonary Medicine; Sensitivity and Specificity; Young Adult
PubMed: 26492064
DOI: 10.1002/cncy.21637 -
Journal of the Formosan Medical... Nov 2020Rapid on-site cytologic evaluation (ROSE) has been shown to improve the diagnostic accuracy of endobronchial ultrasound-guided transbronchial biopsy (EBUS-TBB). However,...
BACKGROUND/PURPOSE
Rapid on-site cytologic evaluation (ROSE) has been shown to improve the diagnostic accuracy of endobronchial ultrasound-guided transbronchial biopsy (EBUS-TBB). However, ROSE by a cytopathologist or cytotechnologist is not always available during the procedure. The purposes of this study were to verify that a pulmonologist, after receiving training in cytology, could accurately assess an EBUS-TBB specimen on-site, and to evaluate the contribution of ROSE to EBUS-TBB.
METHODS
A retrospective chart review of patients who underwent EBUS-TBB for diagnosis of peripheral pulmonary lesions (PPLs) from January 2014 to June 2017 was performed. PPLs without a malignant diagnosis were excluded. The ROSE result determined by a pulmonologist was compared to the formal imprint cytologic report and pathologic report. The diagnostic accuracy of EBUS-TBB was also compared between those with and without ROSE.
RESULTS
Two hundred ninety-three patients who underwent 336 EBUS-TBB procedures for PPL diagnosis and were found to have proven malignancy were enrolled. Eighty-six procedures were performed with ROSE. With the formal imprint cytologic diagnosis as the standard, ROSE had 96.9% sensitivity, 68.2% specificity, 89.9% positive predictive value (PPV), 88.2% negative predictive value (NPV), and 89.5% diagnostic accuracy. With the formal pathologic result as the standard, ROSE had 88.2% sensitivity, 80% specificity, 97.1% PPV, 47.1% NPV, and 87.2% diagnostic accuracy, respectively. The diagnostic accuracy was significantly higher when ROSE was performed during EBUS-TBB (88.4% vs 68.0%, P < 0.001).
CONCLUSION
A trained pulmonologist can interpret adequately cytologic smears on-site and effectively improve the accuracy of EBUS-TBB in the diagnosis of PPLs.
Topics: Biopsy; Bronchoscopy; Humans; Lung Neoplasms; Pulmonologists; Retrospective Studies; Ultrasonography, Interventional
PubMed: 31964550
DOI: 10.1016/j.jfma.2020.01.001