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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 -
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 We compared the single-cell transcriptomes from publicly available and unpublished datasets of the lungs in six different species: human (), African green monkey (), pig (), hamster (), rat () and mouse () by employing RNA velocity and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 -
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 -
Translational Lung Cancer Research Apr 2020
PubMed: 32420054
DOI: 10.21037/tlcr.2020.03.15 -
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 -
International Journal of Chronic... 2021Patients with advanced chronic obstructive pulmonary disease (COPD) experience significant symptom burden, leading to poor quality of life. Although guidelines recommend...
INTRODUCTION
Patients with advanced chronic obstructive pulmonary disease (COPD) experience significant symptom burden, leading to poor quality of life. Although guidelines recommend palliative care for these patients, this is not widely implemented and prevents them from receiving optimal care.
OBJECTIVE
A national survey was performed to map the current content and organization of palliative care provision for patients with COPD by pulmonologists and general practitioners (GPs) in the Netherlands.
METHODS
We developed a survey based on previous studies, guidelines and expert opinion. Dutch pulmonologists and GPs were invited to complete the survey between April and August 2019.
RESULTS
130 pulmonologists (15.3%; covering 76% of pulmonology departments) and 305 GPs (28.6%) responded. Median numbers of patients with COPD in the palliative phase treated were respectively 20 and 1.5 per year. 43% of pulmonologists and 9% of GPs reported some formalized agreements regarding palliative care provision. Physicians most often determined the start of palliative care based on clinical expertise or the Surprise Question. 31% of pulmonologists stated that they often or always referred palliative patients with COPD to a specialist palliative care team; a quarter rarely referred. 79% of the respondents mentioned to often or always administer opioids to treat dyspnea. The topics least discussed were non-invasive ventilation and the patient's spiritual needs. The most critical barrier to starting a palliative care discussion was difficulty in predicting the disease course.
CONCLUSION
Although pulmonologists and GPs indicated to regularly address palliative care aspects, palliative care for patients with COPD remains unstructured and little formalized. However, our data revealed a high willingness to improve this care. Clear guidance and standardization of practice are needed to help providers decide when and how to initiate discussions, when to involve specialist palliative care and how to optimize information exchange between care settings.
Topics: General Practitioners; Humans; Netherlands; Palliative Care; Pulmonary Disease, Chronic Obstructive; Pulmonologists; Quality of Life; Surveys and Questionnaires
PubMed: 33814902
DOI: 10.2147/COPD.S293241 -
Journal of Clinical Medicine Jun 2021Within the European Union, air pollution is highest in Poland. The aim of this study was to compare the awareness of Polish pulmonologists and that of patients with...
Within the European Union, air pollution is highest in Poland. The aim of this study was to compare the awareness of Polish pulmonologists and that of patients with respiratory diseases about the impact of air pollution on health. It was a crossover study with voluntary and anonymous participation. The study included 309 pulmonologists and 262 patients with respiratory diseases. The majority of the patients declared good knowledge about the impact of air pollution on health, and only 16% of the pulmonologists declared sufficient knowledge on this topic. The main sources of information on air pollution were radio and television for patients and the medical press for doctors. Doctors rarely informed patients about the impact of air pollution on their disease. Patients followed information on the quality of air in their areas more often than doctors. Polish patients' knowledge about the main sources of air pollution in their areas was higher than the knowledge of pulmonologists. Patients declared knowledge of air pollution standards twice as often as doctors. Patients with respiratory diseases are interested in the effects of air pollution on their health. Polish patients' knowledge about air pollution and its health effects is higher than that of the specialists treating them. Professional education of Polish pulmonologists in this field is needed.
PubMed: 34204758
DOI: 10.3390/jcm10122606 -
The European Respiratory Journal Nov 2006For expert pulmonologists, advanced procedures in medical thoracoscopy are the nonroutine and more complex applications of the method. The main current indications are... (Review)
Review
For expert pulmonologists, advanced procedures in medical thoracoscopy are the nonroutine and more complex applications of the method. The main current indications are the treatment of infected pleural space, forceps lung biopsy and sympathectomy. In parapneumonic effusions and empyema, medical thoracoscopy is as a drainage procedure, intermediate between tube thoracostomy and video-assisted thoracoscopic surgery (VATS), which is efficient, significantly lower in cost and avoids surgical thoracoscopy under general anaesthesia. It is essential that it is performed early in the course of the disease and is particularly advisable for frail patients at high surgical risk. The efficacy of forceps lung biopsy has been demonstrated in diffuse lung diseases, whereas results in localised lung diseases and chest-wall lesions have been less positive. However, VATS is currently the preferred approach for these indications. The technique still maintains its efficacy for visceral pleura and peripheral lung biopsy, in particular in the presence of pleural effusion and lung disorders. At the present time, thoracoscopic sympathectomy is minimally invasive and is an accepted intervention for patients with a variety of autonomous nervous system disturbances. Essential hyperhidrosis patients, and well-selected patients with other disorders, can be helped with this procedure, which can also be performed by interventional pulmonologists.
Topics: Biopsy; Empyema; Humans; Pleural Effusion; Sympathectomy; Thoracic Surgery, Video-Assisted; Thoracoscopy
PubMed: 17074920
DOI: 10.1183/09031936.00014106 -
Equipment and procedural setup for interventional pulmonology procedures in the intensive care unit.Journal of Thoracic Disease Aug 2021Procedural setup is an important aspect of any procedure. Interventional pulmonologists provide a procedural practice and have additional expertise in performing... (Review)
Review
Procedural setup is an important aspect of any procedure. Interventional pulmonologists provide a procedural practice and have additional expertise in performing high-risk procedures needed in the critically ill patients in intensive care. Taking the time to plan the procedure setup in advance and having all necessary equipment readily available at the patient's bedside is imperative for procedural services. This is especially essential to ensure patient safety, minimize risk of complications, and improve success for specialized procedures performed by interventional pulmonary in the intensive care unit. In this review we describe the equipment and procedural setup ideal for both pleural and airway procedures. These include flexible diagnostic and therapeutic bronchoscopy, ultrasound guided thoracentesis, chest tube insertion, difficult airway management, and bedside percutaneous dilatation tracheostomy. We provide a guide checklist for these procedures emphasizing the practical aspects of each procedure from selecting the appropriate size endotracheal tube to operator positioning to ensure efficiency and best access. The components of procedural setup are discussed in relation to patient factors that include patient positioning and anesthesia, personnel in the procedure team and the equipment itself. We further briefly describe the additional equipment needed for specialized techniques in therapeutic bronchoscopy used by interventional pulmonologists.
PubMed: 34527369
DOI: 10.21037/jtd-20-3595 -
Advances in Therapy Nov 2022Chronic obstructive pulmonary disease (COPD) and asthma are treatable but greatly underdiagnosed disorders. Telemedicine made it possible to continue diagnosis,...
INTRODUCTION
Chronic obstructive pulmonary disease (COPD) and asthma are treatable but greatly underdiagnosed disorders. Telemedicine made it possible to continue diagnosis, follow-up visits and treatment modifications during the COVID-19 pandemic. The present study describes the management of patients with COPD and asthma, and their treatments during the pandemic from the pulmonologist's perspective.
METHODS
NEUMOBIAL was an ecological study with aggregated data. A total of 279 Spanish pulmonologists answered a 60-question survey about their last 10 patients, focused on the characterisation and changes in visits and treatments during the pandemic.
RESULTS
Most pulmonologists (72.0%) considered that the pandemic negatively altered the diagnosis and follow-up of patients with asthma or COPD. Diagnostic tests were reduced during the pandemic, mainly because they were not recommended by pulmonologists (68.1% and 72.7% in the case of COPD and asthma tests, respectively). Moreover, 17.3% of the COPD and 19.1% of the asthma visits were remote visits. According to pulmonologists, low adherence to treatment was mainly due to a lack of patient knowledge about their disease (75.3% and 81.7% in COPD and asthma, respectively). Other factors that also influenced adherence were inadequate use of the inhaler (59.5% for COPD and 57.7% for asthma) and a lack of knowledge about the device (57.3% for COPD and 57.7% for asthma). Pulmonologists chose Zonda for COPD because of the ease of use of the device (73.1%) and the ability to check whether the entire dose was inhaled (69.5%). For asthma, Spiromax was chosen because of the ease of use of the device (85.7%) and the possibility of using a single device for maintenance and reliever treatment (82.4%).
CONCLUSION
According to pulmonologists, during the pandemic, treatments for COPD and asthma were mainly chosen on the basis of their ease of use; treatment adherence was good; and the number of remote visits increased.
Topics: Administration, Inhalation; Asthma; COVID-19; Humans; Pandemics; Pulmonary Disease, Chronic Obstructive; Pulmonologists
PubMed: 36114950
DOI: 10.1007/s12325-022-02313-z