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Revue Des Maladies Respiratoires Apr 2019Dyspnea results from an imbalance between ventilatory demand (linked to CO production, PaCO set-point and wasted ventilation-physiological dead space) and ventilatory... (Review)
Review
Dyspnea results from an imbalance between ventilatory demand (linked to CO production, PaCO set-point and wasted ventilation-physiological dead space) and ventilatory capacity (linked to passive-compliance, resistance-and active-respiratory muscles-components of the respiratory system). Spirometry and static lung volumes investigate ventilatory capacity only. Ventilatory demand (increased for instance in all pulmonary vascular diseases due to increased physiological dead space) is not evaluated by these routine measurements. DLCO measurement, which evaluates both demand and capacity, depicts the best statistical correlation to dyspnea, for instance in obstructive and interstitial pulmonary diseases. Dyspnea has multiple domains and is inherently complex and weakly explained by resting investigations: explained variance is below 50%. The diagnostic strategy investigating dyspnea has to distinguish complaints related or not to exercise because dyspnea can occur independently from any effort. Cardiopulmonary exercise testing (V'O2, V'CO2, V'E and operating lung volumes measurements) allows the assessment of underlying pathophysiological mechanisms leading to functional impairment and can contribute to unmask potential underlying mechanisms of unexplained dyspnea although its "etiological diagnostic value" for dyspnea remains a challenging issue.
Topics: Diagnosis, Differential; Dyspnea; Exercise Test; Humans; Lung Volume Measurements; Practice Patterns, Physicians'; Predictive Value of Tests; Pulmonologists; Respiratory Function Tests; Spirometry
PubMed: 31010751
DOI: 10.1016/j.rmr.2019.02.005 -
Critical Care (London, England) Jun 2020
Topics: COVID-19; Coronavirus Infections; Disease Outbreaks; Hospital Bed Capacity; Hospital Units; Humans; Intensive Care Units; Italy; Pandemics; Pneumonia, Viral; Pulmonary Medicine
PubMed: 32600461
DOI: 10.1186/s13054-020-03087-y -
International Journal of Clinical... 2022Propofol-based sedation provides faster recovery than midazolam-based regimens with similar safety and comfort during video flexible bronchoscope (VFB) procedures....
Propofol-based sedation provides faster recovery than midazolam-based regimens with similar safety and comfort during video flexible bronchoscope (VFB) procedures. Pulmonologist-administered propofol "balanced" analgosedation (PAP-BAS) is still debated in Italy. In this real-life study, PAP-BAS safety and comfort during VFB procedures were investigated. We analysed prospectively the subjects undergoing elective VFB procedures in the Pulmonology and RICU of Arezzo Hospital between February and July 2019. PAP-BAS combined low propofol and meperidine doses titrated to achieve an RASS score between 0 and -3. The primary end-point was the complications' rate. Secondary end-points were as follows: the relation between propofol's dose and a subject's comfort assessed with a VAS, recovery time according to a modified Aldrete score ≥9, RASS, and subjects' will of undergoing the procedure again. We collected postprocedure symptoms' intensity too. Our 158 study patients (67 years; SD ± 14; 64% males) incurred in 25% of complication, fully resolved with medical therapy. Neither recourse to ventilator support nor death was reported. Intraprocedural comfort was good (94% of VAS score ≤2). Among postprocedural symptoms, cough was the most frequently reported, in 36% of the cases. Although half of subjects remembered the procedure, 90% of them would have repeated it, if necessary. 85% of them recovered from procedures within 10 minutes. Complications, VAS, and recovery time were not correlated with propofol dose. To our knowledge, this is the first Italian study showing that PAP-BAS to perform a VFB procedure is safe, well tolerated with a quick recovery. Randomised controlled trials are warranted to confirm these preliminary results.
Topics: Conscious Sedation; Female; Humans; Hypnotics and Sedatives; Male; Meperidine; Midazolam; Propofol; Pulmonologists
PubMed: 35814307
DOI: 10.1155/2022/3368077 -
Respiratory impairment in Niemann-Pick B disease: Two case reports and review for the pulmonologist.Respiratory Medicine and Research Nov 2019Acid sphingomyelinase deficiency (ASMD), also called Niemann-Pick disease, is a storage disorder with pulmonary involvement but few respiratory symptoms in adults.... (Review)
Review
Acid sphingomyelinase deficiency (ASMD), also called Niemann-Pick disease, is a storage disorder with pulmonary involvement but few respiratory symptoms in adults. However, the disease may evolve towards clinically relevant respiratory symptoms with referral to the pulmonologist for management and care. Based on two case reports illustrating respiratory impairment, the aim of this work was to review clinical features, diagnosis, respiratory prognostic and therapeutics for the pulmonologist. Overall, storage disorder should be suspected in the presence of hepatosplenomegaly and interstitial lung disease. Concomitant thrombopenia or hyperlipidemia should also draw attention. Following recent consensus guidelines, diagnosis is based on enzyme assay for ASM activity in blood, with subsequent gene sequencing once the biochemical diagnosis has been confirmed. Disease is slowly progressive and the main causes of death are respiratory and liver failure. Presence of emphysema lesions or worsening of respiratory symptoms should call for the intensification of treatment. Though enzyme replacement therapy is a promising way of development, lung transplantation might be considered for these patients in the absence of contraindication.
Topics: Adult; Enzyme Replacement Therapy; Humans; Lung Diseases, Interstitial; Lung Transplantation; Male; Middle Aged; Niemann-Pick Diseases; Practice Guidelines as Topic; Pulmonologists; Referral and Consultation; Respiratory Insufficiency
PubMed: 31254945
DOI: 10.1016/j.resmer.2019.05.001 -
Clinical Lung Cancer Nov 2013In the growing era of personalized medicine for the treatment of non-small-cell lung cancer (NSCLC), it is becoming increasingly important that sufficient quality and... (Review)
Review
In the growing era of personalized medicine for the treatment of non-small-cell lung cancer (NSCLC), it is becoming increasingly important that sufficient quality and quantity of tumor tissue are available for morphologic diagnosis and molecular analysis. As new treatment options emerge that might require more frequent and possibly higher volume biopsies, the role of the pulmonologist will expand, and it will be important for pulmonologists to work within a multidisciplinary team to provide optimal therapeutic management for patients with NSCLC. In this review, we discuss the rationale for individualized treatment decisions for patients with NSCLC, molecular pathways and specific molecular predictors relevant to personalized NSCLC therapy, assay technologies for molecular marker analysis, and specifics regarding tumor specimen selection, acquisition, and handling. Moreover, we briefly address issues regarding racial and socioeconomic disparities as they relate to molecular testing and treatment decisions, and cost considerations for molecular testing and targeted therapies in NSCLC. We also propose a model for an institution-based multidisciplinary team, including oncologists, pathologists, pulmonologists, interventional radiologists, and thoracic surgeons, to ensure adequate material is available for cytological and histological studies and to standardize methods of tumor specimen handling and processing in an effort to provide beneficial, individualized therapy for patients with NSCLC.
Topics: Biomarkers, Tumor; Biopsy; Carcinoma, Non-Small-Cell Lung; Humans; Interdisciplinary Communication; Lung Neoplasms; Precision Medicine; Pulmonary Medicine; Socioeconomic Factors; Specimen Handling
PubMed: 24188629
DOI: 10.1016/j.cllc.2013.04.002 -
Respirology (Carlton, Vic.) Mar 2005Haemoptysis is the expectoration of blood from the respiratory tract and is life-threatening when blood obstructs the major airway causing asphyxiation. This may occur... (Review)
Review
Haemoptysis is the expectoration of blood from the respiratory tract and is life-threatening when blood obstructs the major airway causing asphyxiation. This may occur in the presence or absence of pre-existing compromised pulmonary reserve and medical comorbidities. Life-threatening haemoptysis is a relatively common clinical situation encountered by pulmonologists and thoracic embolotherapy is a key therapeutic option. Although thoracic embolotherapy primarily involves bronchial arterial embolization, it also encompasses embolization of non-bronchial systemic arteries and the pulmonary arterial supply. A pulmonologist's perspective on this topic is presented. Pertinent areas related to this theme, namely surgery and the role of bronchoscopy in life-threatening haemoptysis are discussed briefly.
Topics: Bronchi; Bronchoscopy; Embolization, Therapeutic; Hemoptysis; Humans; Risk Factors
PubMed: 15823176
DOI: 10.1111/j.1440-1843.2005.00699.x -
Respirology (Carlton, Vic.) May 2019
Topics: Biopsy, Needle; Bronchoscopy; Electromagnetic Phenomena; Humans; Pulmonologists
PubMed: 30803118
DOI: 10.1111/resp.13508 -
Respiration; International Review of... 2018
Topics: Bronchial Neoplasms; Carcinoid Tumor; Humans; Pulmonologists
PubMed: 29462808
DOI: 10.1159/000486424 -
Clinics in Chest Medicine Mar 2011Radiography of the chest, head, neck, teeth, or extremity exposes the embryo or ovary to insignificant exposures of radiation except when radionuclides are utilized. In... (Review)
Review
Radiography of the chest, head, neck, teeth, or extremity exposes the embryo or ovary to insignificant exposures of radiation except when radionuclides are utilized. In some instances, there is no exposure at all. Pulmonologists are fortunate with regard to the specific studies they request to provide clinical care because most of the diagnostic tests do not directly expose the uterus (embryo) or ovary. This article discusses radiation risks and their evaluation and pregnancy-related issues in diagnostic radiological studies.
Topics: Embryonic Development; Female; Humans; Neoplasms, Radiation-Induced; Physician's Role; Pregnancy; Pregnancy Complications; Prenatal Care; Prenatal Exposure Delayed Effects; Pulmonary Medicine; Radiography; Radiotherapy; Reproduction; Risk
PubMed: 21277447
DOI: 10.1016/j.ccm.2010.10.002 -
Respirology (Carlton, Vic.) Jun 2023
Topics: Humans; Lung Neoplasms; Early Detection of Cancer; Pulmonologists; Surgeons
PubMed: 36972923
DOI: 10.1111/resp.14496