Pub Date : 2020-07-01DOI: 10.1097/CPM.0000000000000362
S. Vakili, H. Akbari, S. Jamalnia
Over the past 20 years, a series of major outbreaks of acute respiratory infections such as 2009 influenza A (H1N1) and the 2019 new coronavirus disease (2019-nCoV) have arisen and posed a major threat to the health of the global population. The outbreak of coronavirus calls to mind the pandemics that have instilled great fear in our memories such as severe acute respiratory syndrome (SARS), Zika virus (ZIKV), Middle East respiratory syndrome (MERS), and H1N1 flu. The 2 prominent outbreaks, 2019-nCoV and H1N1, have markedly affected humans. In this study, therefore, we compared some clinical, demographic, and laboratory findings to determine the differences between H1N1 influenza and coronavirus disease-2019 (COVID-19) to suggest the appropriate drug therapeutic approaches. Subsequent to the inclusion of 4 available studies, which presented all the required data, the findings and results were compared, showing fever and cough as the most prevalent clinical indications of both H1N1 influenza and 2019-nCoV diseases. With respect to the laboratory findings, both 2019-nCoV and H1N1 patients showed leukopenia as the main laboratory findings. Taken together, since similar diagnostic methods are used for H1N1 and 2019-nCoV patients and they have the same clinical and laboratory features, it is safe to say that lopinavir/ritonavir and nucleoside analogues could be drug treatment options for patients suffering from 2019-nCoV. However, given the current urgent condition, the primary and main intervention procedure is controlling the infection so as to halt the dissemination of COVID-19. It is recommended, however, that the providers of public health care maintain a close watch on the situation, because the more information we obtain about this new virus and the ensuing epidemic, the faster we can react.
{"title":"Clinical and Laboratory Findings on the Differences Between H1N1 Influenza and Coronavirus Disease-2019 (COVID-19): Focusing on the Treatment Approach","authors":"S. Vakili, H. Akbari, S. Jamalnia","doi":"10.1097/CPM.0000000000000362","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000362","url":null,"abstract":"Over the past 20 years, a series of major outbreaks of acute respiratory infections such as 2009 influenza A (H1N1) and the 2019 new coronavirus disease (2019-nCoV) have arisen and posed a major threat to the health of the global population. The outbreak of coronavirus calls to mind the pandemics that have instilled great fear in our memories such as severe acute respiratory syndrome (SARS), Zika virus (ZIKV), Middle East respiratory syndrome (MERS), and H1N1 flu. The 2 prominent outbreaks, 2019-nCoV and H1N1, have markedly affected humans. In this study, therefore, we compared some clinical, demographic, and laboratory findings to determine the differences between H1N1 influenza and coronavirus disease-2019 (COVID-19) to suggest the appropriate drug therapeutic approaches. Subsequent to the inclusion of 4 available studies, which presented all the required data, the findings and results were compared, showing fever and cough as the most prevalent clinical indications of both H1N1 influenza and 2019-nCoV diseases. With respect to the laboratory findings, both 2019-nCoV and H1N1 patients showed leukopenia as the main laboratory findings. Taken together, since similar diagnostic methods are used for H1N1 and 2019-nCoV patients and they have the same clinical and laboratory features, it is safe to say that lopinavir/ritonavir and nucleoside analogues could be drug treatment options for patients suffering from 2019-nCoV. However, given the current urgent condition, the primary and main intervention procedure is controlling the infection so as to halt the dissemination of COVID-19. It is recommended, however, that the providers of public health care maintain a close watch on the situation, because the more information we obtain about this new virus and the ensuing epidemic, the faster we can react.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"27 1","pages":"87 - 93"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000362","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41950137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-07-01DOI: 10.1097/CPM.0000000000000363
Nevhiz Gundogdu, N. Benlier
This study aimed to evaluate knowledge and skills in the use of inhaler devices in patients with asthma and chronic obstructive pulmonary disease who presented to our clinic for the first time. The patients were enrolled in the study by a pulmonologist. All patients were asked to demonstrate how they used their inhaler device and were assigned scores for their performance. A total of 108 patients were enrolled in the study. Discus (36.1%) and Aerolizer (31.5%) were the most commonly used devices. Patients of both sexes made more errors in the 2 steps of inhaler use (putting the device into the mouth and holding breath after inhalation) in comparison to other steps, with no significant sex difference (49.1% of the females, 62.7% of the males; P=0.15 and 0.62, respectively). Higher education level was associated with higher total scores, greater dexterity, and perceived therapeutic benefit in relation to the correct use of the inhaler device (P<0.001, 0.006, and 0.017, respectively). No statistically significant differences were observed in total scores, ease of use of the device, and perceived benefit from treatment in relation to the inhaler device used (P=0.148, 0.114, and 0.994, respectively). No significant impact of the initial training provider was found on total scores, ease of use, and perceived therapeutic benefit (P=0.073, 0.201, and 0.292, respectively). Total scores, ease of use, and perceived therapeutic benefit increased with higher level of education. However, the person providing education on the inhaler technique had no significant impact on these variables.
{"title":"Evaluation of Knowledge and Skills of Patients With Asthma and COPD in Using Inhaled Therapy","authors":"Nevhiz Gundogdu, N. Benlier","doi":"10.1097/CPM.0000000000000363","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000363","url":null,"abstract":"This study aimed to evaluate knowledge and skills in the use of inhaler devices in patients with asthma and chronic obstructive pulmonary disease who presented to our clinic for the first time. The patients were enrolled in the study by a pulmonologist. All patients were asked to demonstrate how they used their inhaler device and were assigned scores for their performance. A total of 108 patients were enrolled in the study. Discus (36.1%) and Aerolizer (31.5%) were the most commonly used devices. Patients of both sexes made more errors in the 2 steps of inhaler use (putting the device into the mouth and holding breath after inhalation) in comparison to other steps, with no significant sex difference (49.1% of the females, 62.7% of the males; P=0.15 and 0.62, respectively). Higher education level was associated with higher total scores, greater dexterity, and perceived therapeutic benefit in relation to the correct use of the inhaler device (P<0.001, 0.006, and 0.017, respectively). No statistically significant differences were observed in total scores, ease of use of the device, and perceived benefit from treatment in relation to the inhaler device used (P=0.148, 0.114, and 0.994, respectively). No significant impact of the initial training provider was found on total scores, ease of use, and perceived therapeutic benefit (P=0.073, 0.201, and 0.292, respectively). Total scores, ease of use, and perceived therapeutic benefit increased with higher level of education. However, the person providing education on the inhaler technique had no significant impact on these variables.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"27 1","pages":"94 - 98"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000363","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46173784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-07-01DOI: 10.1097/CPM.0000000000000369
C. Jokerst, P. Panse, E. Jensen, K. Cummings, M. Gotway
In late 2019, an acute, severe lower respiratory tract illness of unknown etiology, linked to contact with a live seafood and animal market, was reported in Wuhan City, Hubei Province, China, subsequently shown to be caused by a novel coronavirus termed the Severe Acute Respiratory Syndrome (SARS) Coronavirus (CoV)-2. The infection caused by this virus is referred to as coronavirus disease 2019, or COVID-19. SARS-CoV-2 infects human cells through binding of viral surface spike protein to human angiotensin-converting enzyme 2 receptors, predominantly expressed on Type II alveolar cells, in the lung. SARS-CoV-2 is highly transmissible, and affected patients can transmit the infection while asymptomatic. Patients commonly complain of fever, dry cough, fatigue, myalgias, headache, and dyspnea. Most infected patients have mild disease and recover, with more severe disease and mortality more commonly present in older individuals and patients with comorbidities, such as hypertension, diabetes, and chronic cardiovascular and respiratory conditions. The diagnosis of COVID-19 is typically established through identification of viral nucleic acid at real-time reverse transcriptase polymerase chain reaction on respiratory tract samples. Chest radiography in COVID-19 infection may be normal; when abnormal, patchy areas of lower lobe ground-glass opacity and/or consolidation are seen. Computed tomography is more sensitive than chest radiography for detection of the infection and commonly shows multifocal, bilateral, peripheral, and basal predominant round or oval areas of ground-glass opacity that may subsequently transition to consolidation. Treatment for COVID-19 is currently supportive, with various ongoing trials evaluating a number of potentially therapeutic agents.
{"title":"Déjà Vu All Over Again","authors":"C. Jokerst, P. Panse, E. Jensen, K. Cummings, M. Gotway","doi":"10.1097/CPM.0000000000000369","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000369","url":null,"abstract":"In late 2019, an acute, severe lower respiratory tract illness of unknown etiology, linked to contact with a live seafood and animal market, was reported in Wuhan City, Hubei Province, China, subsequently shown to be caused by a novel coronavirus termed the Severe Acute Respiratory Syndrome (SARS) Coronavirus (CoV)-2. The infection caused by this virus is referred to as coronavirus disease 2019, or COVID-19. SARS-CoV-2 infects human cells through binding of viral surface spike protein to human angiotensin-converting enzyme 2 receptors, predominantly expressed on Type II alveolar cells, in the lung. SARS-CoV-2 is highly transmissible, and affected patients can transmit the infection while asymptomatic. Patients commonly complain of fever, dry cough, fatigue, myalgias, headache, and dyspnea. Most infected patients have mild disease and recover, with more severe disease and mortality more commonly present in older individuals and patients with comorbidities, such as hypertension, diabetes, and chronic cardiovascular and respiratory conditions. The diagnosis of COVID-19 is typically established through identification of viral nucleic acid at real-time reverse transcriptase polymerase chain reaction on respiratory tract samples. Chest radiography in COVID-19 infection may be normal; when abnormal, patchy areas of lower lobe ground-glass opacity and/or consolidation are seen. Computed tomography is more sensitive than chest radiography for detection of the infection and commonly shows multifocal, bilateral, peripheral, and basal predominant round or oval areas of ground-glass opacity that may subsequently transition to consolidation. Treatment for COVID-19 is currently supportive, with various ongoing trials evaluating a number of potentially therapeutic agents.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"27 1","pages":"118 - 122"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000369","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49308598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-07-01DOI: 10.1097/CPM.0000000000000365
A. Fiorelli, Alfonso Pecoraro, A. Carlucci, M. Santini, P. Shah, V. Fang
The ideal type of sedation during endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA) is still a matter of debate. We evaluated whether depth of sedation could affect the EBUS-TBNA results. We reviewed the literature until February 2020, and 11 studies (7 retrospective; 2 prospective observational; and 2 randomized controlled) provided the most applicable evidence to answer the question. All studies but one found that the depth of sedation did not affect diagnostic yield. Eight papers counted the number of lesions sampled per patient, and all studies but 1 found higher number of lesions biopsied with deep sedation. Seven papers counted the number of needle passes per lesion; 4 studies found higher number of passes with deep sedation; 1 study with conscious sedation; and 2 studies found no difference. Four studies evaluated lesion size, and 2 studies found smaller lesion biopsied with deep sedation. Ten papers evaluated complication rates, and 6 of these also analyzed escalation in level of care. All studies but one found that the depth of sedation was not significantly correlated with complication rates. Three studies evaluated patient satisfaction, showing no difference in relation to the depth of sedation. Only one study evaluated the cost of the procedure and found that deep sedation was associated with higher cost compared with conscious sedation. The depth of sedation did not affect EBUS-TBNA outcomes. Thus, conscious sedation and deep sedation remain 2 available strategies for EBUS-TBNA. The choice of one rather than the other strategy should be made considering several factors including physician’s experience, patient’s clinical history (ie, anxiety levels, psychotropic drug use, education level), the aim of EBUS-TBNA (ie, staging, diagnosis), and hospital local policy (availability of operating room and anesthesiologist).
{"title":"Best Evidence Topic: Does the Depth of Sedation Affect Diagnostic Yield of Endobronchial Ultrasound–guided Transbronchial Needle Aspiration?","authors":"A. Fiorelli, Alfonso Pecoraro, A. Carlucci, M. Santini, P. Shah, V. Fang","doi":"10.1097/CPM.0000000000000365","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000365","url":null,"abstract":"The ideal type of sedation during endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA) is still a matter of debate. We evaluated whether depth of sedation could affect the EBUS-TBNA results. We reviewed the literature until February 2020, and 11 studies (7 retrospective; 2 prospective observational; and 2 randomized controlled) provided the most applicable evidence to answer the question. All studies but one found that the depth of sedation did not affect diagnostic yield. Eight papers counted the number of lesions sampled per patient, and all studies but 1 found higher number of lesions biopsied with deep sedation. Seven papers counted the number of needle passes per lesion; 4 studies found higher number of passes with deep sedation; 1 study with conscious sedation; and 2 studies found no difference. Four studies evaluated lesion size, and 2 studies found smaller lesion biopsied with deep sedation. Ten papers evaluated complication rates, and 6 of these also analyzed escalation in level of care. All studies but one found that the depth of sedation was not significantly correlated with complication rates. Three studies evaluated patient satisfaction, showing no difference in relation to the depth of sedation. Only one study evaluated the cost of the procedure and found that deep sedation was associated with higher cost compared with conscious sedation. The depth of sedation did not affect EBUS-TBNA outcomes. Thus, conscious sedation and deep sedation remain 2 available strategies for EBUS-TBNA. The choice of one rather than the other strategy should be made considering several factors including physician’s experience, patient’s clinical history (ie, anxiety levels, psychotropic drug use, education level), the aim of EBUS-TBNA (ie, staging, diagnosis), and hospital local policy (availability of operating room and anesthesiologist).","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"27 1","pages":"105 - 112"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000365","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47679014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-07-01DOI: 10.1097/CPM.0000000000000366
J. Mclaughlin, Chang Liu, Devon T. Collins, K. Webster, Brant G Wang, H. Mani, A. Mahajan
Traditionally, endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA) has been used for the diagnosis of malignant and benign diseases of the lung involving the mediastinum. Unfortunately, obtaining adequate tissue collection, which is necessary for genetic testing in the setting of malignant disease, can pose a challenge using transbronchial needle aspiration. Endobronchial ultrasound–guided intranodal forceps (EBUS-INF) biopsy is a novel technique that can safely and effectively obtain larger tissue samples when paired with EBUS-TBNA. This technology could allow for more timely diagnosis in both malignant and granulomatous diseases. The aim of this study was to describe EBUS-INF as a safe and effective technique for obtaining intranodal lymph node biopsies when used in conjunction with EBUS-TBNA. A secondary aim was to determine concordance between EBUS-TBNA and EBUS-INF on the basis of diagnostic yield. This was a single-center, retrospective, descriptive analysis of 88 EBUS-INF cases for mediastinal and/or hilar lymphadenopathy in 84 patients. A standard endobronchial ultrasound bronchoscopy was performed with EBUS-TBNA and followed by EBUS-INF biopsy to determine concordance of any given diagnosis. The EBUS-INF procedure was performed using the 1.2 mm Boston Scientific Microforceps or Olympus pediatric forceps. Overall agreement between 2 procedures was assessed using Cohen κ where agreement for each individual diagnosis was tested using McNemar test. The EBUS-INF procedure was safely performed in 88 cases and was concordant with the results of the transbronchial needle aspiration biopsies in 86.1% of cases after excluding nondiagnostic cases (Cohen κ=0.82) with only 1.1% complication rate. The one complication was minimal radiographic pneumomediastinum noted on postprocedure chest radiograph. The patient did not require further intervention. This study suggests that EBUS-INF is an effective and safe method for the sampling of mediastinal and/or hilar lymph nodes when performed in conjunction with EBUS-TBNA. There is a trend toward higher likelihood of a diagnosis of granulomatous disease or lymphoma when EBUS-INF is used compared with EBUS-TBNA alone.
传统上，支气管内超声引导的经支气管针吸（EBUS-TBNA）已用于诊断累及纵隔的肺部恶性和良性疾病。不幸的是，获得足够的组织采集，这对于恶性疾病的基因检测是必要的，使用经支气管针抽吸可能会带来挑战。支气管内超声引导的节内钳（EBUS-INF）活检是一种新技术，与EBUS-TBNA配对可以安全有效地获得更大的组织样本。这项技术可以更及时地诊断恶性和肉芽肿性疾病。本研究的目的是将EBUS-INF描述为与EBUS-TBNA联合使用时获得结内淋巴结活检的一种安全有效的技术。第二个目的是在诊断率的基础上确定EBUS-TBNA和EBUS-INF之间的一致性。这是对84名患者中88例纵隔和/或肺门淋巴结病EBUS-INF病例的单中心回顾性描述性分析。使用EBUS-TBNA进行标准支气管内超声支气管镜检查，然后进行EBUS-INF活检，以确定任何给定诊断的一致性。EBUS-INF程序使用1.2 mm Boston Scientific Microforceps或Olympus儿科镊子。使用Cohenκ评估2个程序之间的总体一致性，其中使用McNemar检验测试每个单独诊断的一致性。EBUS-INF手术在88例病例中安全进行，在排除非诊断病例（Cohenκ=0.82）后，86.1%的病例与经支气管针吸活检结果一致，并发症发生率仅为1.1%。一个并发症是术后胸部X线片上发现的最小纵隔气肿。患者无需进一步干预。本研究表明，当与EBUS-TBNA联合进行时，EBUS-INF是一种有效且安全的纵隔和/或肺门淋巴结取样方法。与单独使用EBUS-TBNA相比，使用EBUS-INF诊断肉芽肿性疾病或淋巴瘤的可能性更高。
{"title":"The Safety and Feasibility of Endobronchial Ultrasound Bronchoscopy–guided Intranodal Forceps Biopsies (EBUS-INF)","authors":"J. Mclaughlin, Chang Liu, Devon T. Collins, K. Webster, Brant G Wang, H. Mani, A. Mahajan","doi":"10.1097/CPM.0000000000000366","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000366","url":null,"abstract":"Traditionally, endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA) has been used for the diagnosis of malignant and benign diseases of the lung involving the mediastinum. Unfortunately, obtaining adequate tissue collection, which is necessary for genetic testing in the setting of malignant disease, can pose a challenge using transbronchial needle aspiration. Endobronchial ultrasound–guided intranodal forceps (EBUS-INF) biopsy is a novel technique that can safely and effectively obtain larger tissue samples when paired with EBUS-TBNA. This technology could allow for more timely diagnosis in both malignant and granulomatous diseases. The aim of this study was to describe EBUS-INF as a safe and effective technique for obtaining intranodal lymph node biopsies when used in conjunction with EBUS-TBNA. A secondary aim was to determine concordance between EBUS-TBNA and EBUS-INF on the basis of diagnostic yield. This was a single-center, retrospective, descriptive analysis of 88 EBUS-INF cases for mediastinal and/or hilar lymphadenopathy in 84 patients. A standard endobronchial ultrasound bronchoscopy was performed with EBUS-TBNA and followed by EBUS-INF biopsy to determine concordance of any given diagnosis. The EBUS-INF procedure was performed using the 1.2 mm Boston Scientific Microforceps or Olympus pediatric forceps. Overall agreement between 2 procedures was assessed using Cohen κ where agreement for each individual diagnosis was tested using McNemar test. The EBUS-INF procedure was safely performed in 88 cases and was concordant with the results of the transbronchial needle aspiration biopsies in 86.1% of cases after excluding nondiagnostic cases (Cohen κ=0.82) with only 1.1% complication rate. The one complication was minimal radiographic pneumomediastinum noted on postprocedure chest radiograph. The patient did not require further intervention. This study suggests that EBUS-INF is an effective and safe method for the sampling of mediastinal and/or hilar lymph nodes when performed in conjunction with EBUS-TBNA. There is a trend toward higher likelihood of a diagnosis of granulomatous disease or lymphoma when EBUS-INF is used compared with EBUS-TBNA alone.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"27 1","pages":"113 - 117"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000366","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49592624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-07-01DOI: 10.1097/CPM.0000000000000367
Aaron B. Kaye, F. West, D. Zappetti
C hronic obstructive pulmonary disease (COPD) is a common disorder characterized by respiratory symptoms in the presence of airflow limitation and develops when an individual with risk factors is exposed to a triggering antigen.1 Disease manifests as a combination of parenchymal destruction and airway damage, which progresses over time and in a variety of patterns.1 As clinicians, our ability to identify and manage advanced disease is well-established. However, our ability to discover and preempt early pathology is lacking. Prior studies have utilized cluster analysis to identify disease subtypes on the basis of computed tomography (CT) abnormalities, but were limited by an inability to parse disease phenotype from severity.2 The authors of this study applied the Subtype and Stage Inference (SuStaIn) model to analyze CT imaging data from the COPDGene cross-sectional data set in an attempt to accurately categorize disease subtype and map disease stage. The model compared baseline imaging characteristics of 3698 smokers with COPD with 3479 smoking controls without COPD. Four main imaging variables were examined: emphysema, functional small airway disease (fSAD), square root wall area, and segmental airway wall thickness. Each subtype was defined by a unique trajectory of imaging features over time, and each stage was defined by the relative position along that trajectory. Patients with COPD were assigned probabilistically to a given subtype and stage on the basis of their individual imaging findings reaching a particular z-score relative to the control group. Notable baseline differences between the COPD group and control group included mean age (63.13 vs. 56.90 y), mean smoking history (51.91 pack-years vs. 37.33 packyears), and mean annual exacerbations (0.64 per year vs. 0.13 per year). The SuStaIn model delineated 2 unique disease subtypes, “tissue → airway” and “airway → tissue.” The tissue → airway subtype (n= 2354, 70.4%) demonstrated early emphysema and fSAD, with large airway involvement occurring later in the disease course. Conversely, the airway → tissue subtype (n= 988, 29.6%) demonstrated early large airway damage, with emphysema and fSAD occurring later in the disease course. Patients with the tissue → airway subtype had a lower mean body mass index than those with the airway → tissue subtype (26.65 vs. 30.54, P< 0.001), lower mean FEV1% predicted (53.63% vs. 58.64%, P< 0.001), lower mean FEV1/FVC (0.49 vs. 0.56, P< 0.001), and lower prevalence of chronic bronchitis (25.1% vs. 31.8%, P <0.001). Over a 5-year follow-up, 87% of individuals remained in their initially assigned subtypes. The authors determined that disease stage could be used as a marker of disease severity. In the tissue → airway subtype, stage correlated with decline in FEV1/FVC (r= –0.63, P< 0.001) and FEV1% predicted (r= –0.66, P< 0.001). The nonlinear relationship indicated that more significant decline in lung function occurred during early stages. In the airway →
{"title":"A SuStaIn-able Approach to Modeling COPD Progression?","authors":"Aaron B. Kaye, F. West, D. Zappetti","doi":"10.1097/CPM.0000000000000367","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000367","url":null,"abstract":"C hronic obstructive pulmonary disease (COPD) is a common disorder characterized by respiratory symptoms in the presence of airflow limitation and develops when an individual with risk factors is exposed to a triggering antigen.1 Disease manifests as a combination of parenchymal destruction and airway damage, which progresses over time and in a variety of patterns.1 As clinicians, our ability to identify and manage advanced disease is well-established. However, our ability to discover and preempt early pathology is lacking. Prior studies have utilized cluster analysis to identify disease subtypes on the basis of computed tomography (CT) abnormalities, but were limited by an inability to parse disease phenotype from severity.2 The authors of this study applied the Subtype and Stage Inference (SuStaIn) model to analyze CT imaging data from the COPDGene cross-sectional data set in an attempt to accurately categorize disease subtype and map disease stage. The model compared baseline imaging characteristics of 3698 smokers with COPD with 3479 smoking controls without COPD. Four main imaging variables were examined: emphysema, functional small airway disease (fSAD), square root wall area, and segmental airway wall thickness. Each subtype was defined by a unique trajectory of imaging features over time, and each stage was defined by the relative position along that trajectory. Patients with COPD were assigned probabilistically to a given subtype and stage on the basis of their individual imaging findings reaching a particular z-score relative to the control group. Notable baseline differences between the COPD group and control group included mean age (63.13 vs. 56.90 y), mean smoking history (51.91 pack-years vs. 37.33 packyears), and mean annual exacerbations (0.64 per year vs. 0.13 per year). The SuStaIn model delineated 2 unique disease subtypes, “tissue → airway” and “airway → tissue.” The tissue → airway subtype (n= 2354, 70.4%) demonstrated early emphysema and fSAD, with large airway involvement occurring later in the disease course. Conversely, the airway → tissue subtype (n= 988, 29.6%) demonstrated early large airway damage, with emphysema and fSAD occurring later in the disease course. Patients with the tissue → airway subtype had a lower mean body mass index than those with the airway → tissue subtype (26.65 vs. 30.54, P< 0.001), lower mean FEV1% predicted (53.63% vs. 58.64%, P< 0.001), lower mean FEV1/FVC (0.49 vs. 0.56, P< 0.001), and lower prevalence of chronic bronchitis (25.1% vs. 31.8%, P <0.001). Over a 5-year follow-up, 87% of individuals remained in their initially assigned subtypes. The authors determined that disease stage could be used as a marker of disease severity. In the tissue → airway subtype, stage correlated with decline in FEV1/FVC (r= –0.63, P< 0.001) and FEV1% predicted (r= –0.66, P< 0.001). The nonlinear relationship indicated that more significant decline in lung function occurred during early stages. In the airway → ","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46468810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-01DOI: 10.1097/CPM.0000000000000360
N. Salam, L. Lande, L. Greenspon, D. Zappetti
Synopsis: The FLARE (FlowTriever Pulmonary Embolectomy Clinical Study) is a prospective, single-arm, multicenter trial in which 106 patients at 18 different US sites with intermediate-risk pulmonary embolism (PE) were treated with percutaneous mechanical thrombectomy using the FlowTriever Retrieval/Aspiration System. The investigators found that the FlowTriever device met its primary effectiveness endpoint with a mean reduction in the right ventricular/left ventricular ratio at 48 hours of 0.38 (25.1%; P< 0.00010). Treated patients also had a small decrease in anatomic degree of thrombus (10% by modified Miller score), and those with pulmonary hypertension exhibited a 3.2 mmHg reduction in mean pulmonary artery pressure (P< 0.0001). There were no cases of intracranial hemorrhage, device-related cardiac or pulmonary injury, or device-related deaths. This study introduces an additional modality for the treatment of intermediate to high–risk PE. The change in right ventricular/left ventricular ratio with FlowTriever embolectomy is similar to that noted with other trials investigating catheter-directed thrombolysis and better than that of anticoagulation alone. What sets this device apart from many of its predecessors is that it does not require thrombolytics, offering a safer option to patients with absolute or relative contraindications to systemic thrombolysis. FlowTriever has shown promising results in reducing early right ventricular strain in patients with intermediate-risk PE, but its place in the algorithm in the treatment of PE will more likely be for higher risk PE, especially when relative or absolute contraindications to thrombolysis exist. The long-term benefits for patients with intermediate-risk PE will require further study. Source: Tu T, Toma C, Tapson VF, et al. A prospective, single-arm, multicenter trial of catheter-directed mechanical thrombectomy for intermediate-risk acute pulmonary embolism: the FLARE study. JACC Cardiovasc Interv. 2019:12.9:859–869.
{"title":"Introducing the Flow Triever Mechanical Thrombectomy Device: A Nonthrombolytic Catheter-directed Approach for Intermediate to High–risk Pulmonary Embolism","authors":"N. Salam, L. Lande, L. Greenspon, D. Zappetti","doi":"10.1097/CPM.0000000000000360","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000360","url":null,"abstract":"Synopsis: The FLARE (FlowTriever Pulmonary Embolectomy Clinical Study) is a prospective, single-arm, multicenter trial in which 106 patients at 18 different US sites with intermediate-risk pulmonary embolism (PE) were treated with percutaneous mechanical thrombectomy using the FlowTriever Retrieval/Aspiration System. The investigators found that the FlowTriever device met its primary effectiveness endpoint with a mean reduction in the right ventricular/left ventricular ratio at 48 hours of 0.38 (25.1%; P< 0.00010). Treated patients also had a small decrease in anatomic degree of thrombus (10% by modified Miller score), and those with pulmonary hypertension exhibited a 3.2 mmHg reduction in mean pulmonary artery pressure (P< 0.0001). There were no cases of intracranial hemorrhage, device-related cardiac or pulmonary injury, or device-related deaths. This study introduces an additional modality for the treatment of intermediate to high–risk PE. The change in right ventricular/left ventricular ratio with FlowTriever embolectomy is similar to that noted with other trials investigating catheter-directed thrombolysis and better than that of anticoagulation alone. What sets this device apart from many of its predecessors is that it does not require thrombolytics, offering a safer option to patients with absolute or relative contraindications to systemic thrombolysis. FlowTriever has shown promising results in reducing early right ventricular strain in patients with intermediate-risk PE, but its place in the algorithm in the treatment of PE will more likely be for higher risk PE, especially when relative or absolute contraindications to thrombolysis exist. The long-term benefits for patients with intermediate-risk PE will require further study. Source: Tu T, Toma C, Tapson VF, et al. A prospective, single-arm, multicenter trial of catheter-directed mechanical thrombectomy for intermediate-risk acute pulmonary embolism: the FLARE study. JACC Cardiovasc Interv. 2019:12.9:859–869.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41728453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-01DOI: 10.1097/CPM.0000000000000346
C. Rasmussen, Girish Balachandran Nair, S. Al-katib
Although vaping has been promoted by manufacturers as a safe alternative to traditional smoking, the dangers of vaping and e-cigarette use have come to the forefront of the medical community, particularly the risks associated with tetrahydrocannabinol-containing products. Although many patterns of vaping-associated lung injuries have been reported in the literature, one of the most concerning is that of diffuse alveolar damage. As e-cigarette and vaping use is becoming increasingly popular, particularly in the younger population, it is important to become familiar with this entity to ensure proper and timely diagnosis to prevent lifelong sequelae.
{"title":"A Case of Vaping-associated Acute Lung Injury","authors":"C. Rasmussen, Girish Balachandran Nair, S. Al-katib","doi":"10.1097/CPM.0000000000000346","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000346","url":null,"abstract":"Although vaping has been promoted by manufacturers as a safe alternative to traditional smoking, the dangers of vaping and e-cigarette use have come to the forefront of the medical community, particularly the risks associated with tetrahydrocannabinol-containing products. Although many patterns of vaping-associated lung injuries have been reported in the literature, one of the most concerning is that of diffuse alveolar damage. As e-cigarette and vaping use is becoming increasingly popular, particularly in the younger population, it is important to become familiar with this entity to ensure proper and timely diagnosis to prevent lifelong sequelae.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"27 1","pages":"79 - 82"},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000346","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42268075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-01DOI: 10.1097/CPM.0000000000000357
V. Poberezhets, Oksana Poberezhets
Idiopathic pulmonary hemosiderosis is a rare interstitial lung disease that occurs mostly in childhood. Usually, it presents with diffuse alveolar hemorrhage with no identified etiology. This report describes a young male patient who presented a clinical pattern of fatigue, dyspnea, and hemoptysis with iron-deficiency anemia. The iron-deficiency anemia in this patient was resistant to oral elemental iron therapy. This patient had typical findings on chest computed tomography (diffuse ground-glass opacities of the lungs) and bronchoalveolar lavage (detected siderophages). The patient obtained corticosteroid therapy after confirmation of idiopathic pulmonary hemosiderosis diagnosis, which led to improvement of symptoms in one week. This case report shows that early diagnosis and quick initiation of corticosteroid therapy is an effective approach, which reveals the symptoms and prevents complications.
{"title":"A Case of Idiopathic Pulmonary Hemosiderosis in a 30-Year-Old Man","authors":"V. Poberezhets, Oksana Poberezhets","doi":"10.1097/CPM.0000000000000357","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000357","url":null,"abstract":"Idiopathic pulmonary hemosiderosis is a rare interstitial lung disease that occurs mostly in childhood. Usually, it presents with diffuse alveolar hemorrhage with no identified etiology. This report describes a young male patient who presented a clinical pattern of fatigue, dyspnea, and hemoptysis with iron-deficiency anemia. The iron-deficiency anemia in this patient was resistant to oral elemental iron therapy. This patient had typical findings on chest computed tomography (diffuse ground-glass opacities of the lungs) and bronchoalveolar lavage (detected siderophages). The patient obtained corticosteroid therapy after confirmation of idiopathic pulmonary hemosiderosis diagnosis, which led to improvement of symptoms in one week. This case report shows that early diagnosis and quick initiation of corticosteroid therapy is an effective approach, which reveals the symptoms and prevents complications.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"27 1","pages":"64 - 66"},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000357","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44312902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-01DOI: 10.1097/CPM.0000000000000356
D. El-Qutob, M. Maillo
Bronchial asthma is an extended chronic inflammatory respiratory disease that represents a serious health problem. Management of asthmatic patients should be ensured by the use of asthma guidelines such as Global Initiative for Asthma (GINA). The last changes made in the GINA guide have generated controversy. This article reviews the reasons for the changes in the guide and the problems that could emerge in the management of the asthmatic patient.
{"title":"New GINA Guidelines: Controversy Still Exists","authors":"D. El-Qutob, M. Maillo","doi":"10.1097/CPM.0000000000000356","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000356","url":null,"abstract":"Bronchial asthma is an extended chronic inflammatory respiratory disease that represents a serious health problem. Management of asthmatic patients should be ensured by the use of asthma guidelines such as Global Initiative for Asthma (GINA). The last changes made in the GINA guide have generated controversy. This article reviews the reasons for the changes in the guide and the problems that could emerge in the management of the asthmatic patient.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"27 1","pages":"61 - 63"},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000356","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42659656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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