Pub Date : 2019-07-01DOI: 10.1097/CPM.0000000000000314
A. Gibelin, A. Parrot, M. Fartoukh, N. de Prost
Almost 10% of patients with acute respiratory distress syndrome (ARDS) have no identified ARDS risk factor at ARDS diagnosis. A prompt identification of the cause of ARDS is required to initiate a targeted treatment. The purpose of this review is to delineate the main rare causes of ARDS and to provide clinicians with a pragmatic diagnostic workup. Recent epidemiological data have proposed the identification of a subgroup of ARDS patients lacking exposure to common risk factors. These can be categorized as having immune-mediated, drug-induced, malignant, and idiopathic diseases. A standardized diagnostic workup including chest imaging, the objective assessment of left-heart–filling pressures, bronchoalveolar lavage fluid microbiological investigations, and cytologic analysis, immunologic tests, and search for pneumotoxic drugs may allow for identifying the cause of ARDS in most cases. Open-lung biopsy should be considered in other cases.
{"title":"Etiologies and Outcomes of Acute Respiratory Distress Syndrome With No Identified Common Risk Factor","authors":"A. Gibelin, A. Parrot, M. Fartoukh, N. de Prost","doi":"10.1097/CPM.0000000000000314","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000314","url":null,"abstract":"Almost 10% of patients with acute respiratory distress syndrome (ARDS) have no identified ARDS risk factor at ARDS diagnosis. A prompt identification of the cause of ARDS is required to initiate a targeted treatment. The purpose of this review is to delineate the main rare causes of ARDS and to provide clinicians with a pragmatic diagnostic workup. Recent epidemiological data have proposed the identification of a subgroup of ARDS patients lacking exposure to common risk factors. These can be categorized as having immune-mediated, drug-induced, malignant, and idiopathic diseases. A standardized diagnostic workup including chest imaging, the objective assessment of left-heart–filling pressures, bronchoalveolar lavage fluid microbiological investigations, and cytologic analysis, immunologic tests, and search for pneumotoxic drugs may allow for identifying the cause of ARDS in most cases. Open-lung biopsy should be considered in other cases.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"26 1","pages":"108 - 113"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000314","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45182831","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 : 2019-07-01DOI: 10.1097/CPM.0000000000000316
D. Zappetti
Synopsis: Omadacycline is a new antibiotic, derived from the tetracycline class, which might fill the need for a novel antibiotic that is effective against the common bacterial organisms causing community-acquired pneumonia. This trial showed it to be noninferior to moxifloxacin. Source: Stets R, Popescu M, Gonong JR, et al. Omadacycline for community-acquired bacterial pneumonia. N Engl J Med. 2019;380:517–527.
摘要:奥马达环素是一种新的抗生素，衍生自四环素类，可能填补了对一种新型抗生素的需求，这种抗生素对引起社区获得性肺炎的常见细菌有机体有效。该试验表明其疗效不逊于莫西沙星。资料来源:Stets R, Popescu M, Gonong JR等。奥马达环素治疗社区获得性细菌性肺炎。中华医学杂志，2019;38(5):517 - 527。
{"title":"Omadacycline is a Potential New Drug For Treatment in Moderate to Severe Community-acquired Pneumonia","authors":"D. Zappetti","doi":"10.1097/CPM.0000000000000316","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000316","url":null,"abstract":"Synopsis: Omadacycline is a new antibiotic, derived from the tetracycline class, which might fill the need for a novel antibiotic that is effective against the common bacterial organisms causing community-acquired pneumonia. This trial showed it to be noninferior to moxifloxacin. Source: Stets R, Popescu M, Gonong JR, et al. Omadacycline for community-acquired bacterial pneumonia. N Engl J Med. 2019;380:517–527.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000316","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41904846","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 : 2019-07-01DOI: 10.1097/CPM.0000000000000308
R. Cartin-Ceba, C. Jokerst, E. Jensen, K. Cummings, M. Gotway
Pulmonary nodules detected at thoracic imaging studies are a frequent occurrence. The management of such nodules largely revolves around comparison with prior imaging studies to document stability, and, in the absence of such priors, serial imaging assessment, as determined by the patient’s age, smoking status, and nodule characteristics, including size, border characteristics, and nodule attenuation. Often such incidentally detected nodules, particularly when small, are ultimately shown to be benign through lack of growth at serial imaging assessment, and therefore a conservative approach to these nodules is generally favored. In contrast, larger solid nodules, particularly when >1 cm in size, or cavitation within a nodule, herald a potentially more aggressive, or even an “active,” process that frequently warrants definitive evaluation. Although the differential diagnosis of solid nodules and cavitary nodules is similar, the presence of cavitation often specifically raises the possibility of active infection or malignancy. In addition, the presence of cavitation within a nodular pulmonary opacity can be seen with a number of noninfectious, inflammatory lesions that are treated substantially differently than either infection or malignancy, and therefore definitive diagnosis is usually required in these circumstances. Finally, cavitary lung disorders can result in complications, including spontaneous pneumothorax, hemopneumothorax, pyothorax, and even bronchopleural fistula.
{"title":"A Rare Cause of Spontaneous Pneumothorax","authors":"R. Cartin-Ceba, C. Jokerst, E. Jensen, K. Cummings, M. Gotway","doi":"10.1097/CPM.0000000000000308","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000308","url":null,"abstract":"Pulmonary nodules detected at thoracic imaging studies are a frequent occurrence. The management of such nodules largely revolves around comparison with prior imaging studies to document stability, and, in the absence of such priors, serial imaging assessment, as determined by the patient’s age, smoking status, and nodule characteristics, including size, border characteristics, and nodule attenuation. Often such incidentally detected nodules, particularly when small, are ultimately shown to be benign through lack of growth at serial imaging assessment, and therefore a conservative approach to these nodules is generally favored. In contrast, larger solid nodules, particularly when >1 cm in size, or cavitation within a nodule, herald a potentially more aggressive, or even an “active,” process that frequently warrants definitive evaluation. Although the differential diagnosis of solid nodules and cavitary nodules is similar, the presence of cavitation often specifically raises the possibility of active infection or malignancy. In addition, the presence of cavitation within a nodular pulmonary opacity can be seen with a number of noninfectious, inflammatory lesions that are treated substantially differently than either infection or malignancy, and therefore definitive diagnosis is usually required in these circumstances. Finally, cavitary lung disorders can result in complications, including spontaneous pneumothorax, hemopneumothorax, pyothorax, and even bronchopleural fistula.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"26 1","pages":"130 - 134"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000308","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44567696","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 : 2019-07-01DOI: 10.1097/CPM.0000000000000315
K. Chaithra, V. Shetty, Rekha Rai, Raghav Sharma, A. Shetty
Aeromonas hydrophila belongs to the family Aeromonadaceae and is ubiquitous in distribution. It can be widely isolated from environmental sources such as aquatic habitats, fish, and natural soils. Sepsis due to A. hydrophila infection usually occurs in immunocompromised hosts, but severe infection has been reported in apparently healthy individuals. We report a case of a 40-year-old immunocompetent woman who presented with pneumonia and septic shock secondary to A. hydrophila infection. Her clinical course was complicated by acute respiratory distress syndrome, metabolic acidosis, and multiorgan failure resulting in mortality. The isolate was susceptible to third-generation and fourth-generation cephalosporins, piperacillin-tazobactam, fluoroquinolones, and trimotheprim/sulfamethoxazole. Review of the literature for previous reports of infection with Aeromonas species infection in previously healthy individuals suggests that pneumonia and bacteremia due to A. hydrophila can be often fulminant and fatal. Early diagnosis and initiation of appropriate antibiotic therapy are crucial to reducing morbidity and mortality among patients infected with A. hydrophila. Physicians should be aware of the complications associated with A. hydrophila infection.
{"title":"Fatal Sepsis and Septic Shock Secondary to Aeromonas hydrophila Pneumonia: Report of a Case and Review of the Literature","authors":"K. Chaithra, V. Shetty, Rekha Rai, Raghav Sharma, A. Shetty","doi":"10.1097/CPM.0000000000000315","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000315","url":null,"abstract":"Aeromonas hydrophila belongs to the family Aeromonadaceae and is ubiquitous in distribution. It can be widely isolated from environmental sources such as aquatic habitats, fish, and natural soils. Sepsis due to A. hydrophila infection usually occurs in immunocompromised hosts, but severe infection has been reported in apparently healthy individuals. We report a case of a 40-year-old immunocompetent woman who presented with pneumonia and septic shock secondary to A. hydrophila infection. Her clinical course was complicated by acute respiratory distress syndrome, metabolic acidosis, and multiorgan failure resulting in mortality. The isolate was susceptible to third-generation and fourth-generation cephalosporins, piperacillin-tazobactam, fluoroquinolones, and trimotheprim/sulfamethoxazole. Review of the literature for previous reports of infection with Aeromonas species infection in previously healthy individuals suggests that pneumonia and bacteremia due to A. hydrophila can be often fulminant and fatal. Early diagnosis and initiation of appropriate antibiotic therapy are crucial to reducing morbidity and mortality among patients infected with A. hydrophila. Physicians should be aware of the complications associated with A. hydrophila infection.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"26 1","pages":"114 - 117"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000315","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44465408","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 : 2019-07-01DOI: 10.1097/CPM.0000000000000319
D. Zappetti
economic status and poverty in the community were associated with COPD prevalence. The odds of having COPD increased by 8% with every 1-unit decrease in a person’s income-topoverty ratio. People in the South and the Midwest have more COPD. Overall, the prevalence of COPD in rural, poor communities is twice that seen in the general population. Solid fuel use data are included in the census database. Although the overall use of coal or wood for fuel is low in the United States, a community with a 1% increase in the use of these fuels could be linked to a 9% risk in COPD among nonsmokers in the area. Although not statistically significant, crude modeling showed that increased odds of COPD were seen in people reporting working in the agriculture, construction, or mining industries. Minority groups were less likely to report having COPD, but it is not clear whether this is due to being less susceptible, being screened and diagnosed less, or due to other disparities in care. The major limitation of this study is that people self report their diagnosis of COPD. Care was taken to limit misclassification, but the potential for misrepresentation exists. Data about fuel use was collected at the community level and not the individual level, and other potential risk factors could not be individually assessed. These include early childhood infection, moving between geographic areas and access to care. The strength of the study, however, is the robust data available through the various databases and the ability to evaluate both individual and regional trends. The UCHS data, specifically, allowed the stratification of the responses between poor and nonpoor regions—a breakdown that was illustrative. In this nationally representative sample of Americans, the following characteristics were significant risk factors associated with a higher prevalence of COPD: living in a rural area with a high level of poverty in the community. Among nonsmokers, living in a community that uses coal for heating was an additional risk factor.
{"title":"Revisiting Early Neuromuscular Blockade in the Acute Respiratory Distress Syndrome","authors":"D. Zappetti","doi":"10.1097/CPM.0000000000000319","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000319","url":null,"abstract":"economic status and poverty in the community were associated with COPD prevalence. The odds of having COPD increased by 8% with every 1-unit decrease in a person’s income-topoverty ratio. People in the South and the Midwest have more COPD. Overall, the prevalence of COPD in rural, poor communities is twice that seen in the general population. Solid fuel use data are included in the census database. Although the overall use of coal or wood for fuel is low in the United States, a community with a 1% increase in the use of these fuels could be linked to a 9% risk in COPD among nonsmokers in the area. Although not statistically significant, crude modeling showed that increased odds of COPD were seen in people reporting working in the agriculture, construction, or mining industries. Minority groups were less likely to report having COPD, but it is not clear whether this is due to being less susceptible, being screened and diagnosed less, or due to other disparities in care. The major limitation of this study is that people self report their diagnosis of COPD. Care was taken to limit misclassification, but the potential for misrepresentation exists. Data about fuel use was collected at the community level and not the individual level, and other potential risk factors could not be individually assessed. These include early childhood infection, moving between geographic areas and access to care. The strength of the study, however, is the robust data available through the various databases and the ability to evaluate both individual and regional trends. The UCHS data, specifically, allowed the stratification of the responses between poor and nonpoor regions—a breakdown that was illustrative. In this nationally representative sample of Americans, the following characteristics were significant risk factors associated with a higher prevalence of COPD: living in a rural area with a high level of poverty in the community. Among nonsmokers, living in a community that uses coal for heating was an additional risk factor.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000319","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42164716","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 : 2019-07-01DOI: 10.1097/CPM.0000000000000321
A. Lampkin, C. Bellinger
Emphysema and chronic obstructive pulmonary disease are highly prevalent disease states. Patients with severe emphysematous disease have been shown to benefit from lung volume reduction surgery, at the cost of increased perioperative mortality. Interest in minimally invasive bronchoscopic lung volume reduction has increased over the past 2 decades, with endobronchial valves (EBVs) being the most studied of these modalities. Currently, there are 2 such devices that are US Food and Drug Administration approved, Zephyr and Spiration. Here, we have reviewed the literature with regard to EBV placement, highlighting how previous trials have informed current indications for valve placement. This article also reviews the potential benefits of EBVs and the associated complications. Although bronchial valves have yielded promising results and are a potentially safer alternative to lung volume reduction surgery, further guidelines are needed to improve patient selection and procedure performance. Myth: In severe emphysema, surgical resection is the only option for lung volume reduction.
{"title":"Myths and Legends: Do Bronchial Valves Have a Role in the Management of Emphysema?","authors":"A. Lampkin, C. Bellinger","doi":"10.1097/CPM.0000000000000321","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000321","url":null,"abstract":"Emphysema and chronic obstructive pulmonary disease are highly prevalent disease states. Patients with severe emphysematous disease have been shown to benefit from lung volume reduction surgery, at the cost of increased perioperative mortality. Interest in minimally invasive bronchoscopic lung volume reduction has increased over the past 2 decades, with endobronchial valves (EBVs) being the most studied of these modalities. Currently, there are 2 such devices that are US Food and Drug Administration approved, Zephyr and Spiration. Here, we have reviewed the literature with regard to EBV placement, highlighting how previous trials have informed current indications for valve placement. This article also reviews the potential benefits of EBVs and the associated complications. Although bronchial valves have yielded promising results and are a potentially safer alternative to lung volume reduction surgery, further guidelines are needed to improve patient selection and procedure performance. Myth: In severe emphysema, surgical resection is the only option for lung volume reduction.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000321","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45445186","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 : 2019-05-01DOI: 10.1097/CPM.0000000000000306
Yu‐hui Yang, L. Mok, H. Tai
Supplemental Digital Content is available in the text. Empyema thoracis may be an ancient disease, but it still occurs in present-day thoracic practice. Despite medical and technical progression, pleural infection remains a major health care concern. When empyema thoracis is complicated by bronchopleural fistulae or repeated infections, it becomes a clinical challenge to physicians and can substantially lengthen and complicate a patient’s course of treatment. This case report presents a 48-year-old male patient with chronic empyema and multiple bronchopleural fistulae who was effectively treated by a combination of a 1-way valve and vacuum-assisted closure system through open-window thoracostomy. This combination successfully prevented air accumulation beneath the wound dressing, and therefore it was possible to maintain negative pressure, which is essential for the vacuum-assisted closure system to function.
{"title":"A Novel Therapeutic Approach Using the Combination of Vacuum-assisted Closure System and 1-Way Valve After Open-Window Thoracostomy in Treating Chronic Empyema Complicated by Multiple Bronchopleural Fistulae","authors":"Yu‐hui Yang, L. Mok, H. Tai","doi":"10.1097/CPM.0000000000000306","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000306","url":null,"abstract":"Supplemental Digital Content is available in the text. Empyema thoracis may be an ancient disease, but it still occurs in present-day thoracic practice. Despite medical and technical progression, pleural infection remains a major health care concern. When empyema thoracis is complicated by bronchopleural fistulae or repeated infections, it becomes a clinical challenge to physicians and can substantially lengthen and complicate a patient’s course of treatment. This case report presents a 48-year-old male patient with chronic empyema and multiple bronchopleural fistulae who was effectively treated by a combination of a 1-way valve and vacuum-assisted closure system through open-window thoracostomy. This combination successfully prevented air accumulation beneath the wound dressing, and therefore it was possible to maintain negative pressure, which is essential for the vacuum-assisted closure system to function.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"26 1","pages":"82 - 86"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000306","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48685726","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 : 2019-05-01DOI: 10.1097/CPM.0000000000000305
M. Izquierdo, C. Marion, D. Tumin, M. Bowling, V. Ortega
Bronchoscopy is used in the management of cystic fibrosis (CF) for multiple reasons, of which sampling respiratory secretions has been the most frequent. The evidence behind the role of bronchoscopy for routine sampling of respiratory secretions to determine clinical management is lacking, although there remain well-accepted indications for bronchoscopy in research and follow-up of advanced therapies in the CF population. We review the clinical and research utility of bronchoscopy in patients with CF and outline promising research uses of this tool that can contribute to recent advances in understanding and treating CF.
{"title":"The Clinical and Research Utility of Bronchoscopy in Cystic Fibrosis","authors":"M. Izquierdo, C. Marion, D. Tumin, M. Bowling, V. Ortega","doi":"10.1097/CPM.0000000000000305","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000305","url":null,"abstract":"Bronchoscopy is used in the management of cystic fibrosis (CF) for multiple reasons, of which sampling respiratory secretions has been the most frequent. The evidence behind the role of bronchoscopy for routine sampling of respiratory secretions to determine clinical management is lacking, although there remain well-accepted indications for bronchoscopy in research and follow-up of advanced therapies in the CF population. We review the clinical and research utility of bronchoscopy in patients with CF and outline promising research uses of this tool that can contribute to recent advances in understanding and treating CF.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"26 1","pages":"76 - 81"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000305","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45471209","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 : 2019-05-01DOI: 10.1097/CPM.0000000000000297
I. Goel, P. Kaushik, Vassilis Xydis
Congenital pulmonary airway malformation (CPAM) is an uncommon developmental hamartomatous anomaly caused by abnormal branching of immature bronchioles with replacement of the lung by cysts/disorganized tissue. CPAMs are usually lobar or sublobar in extent, and ∼90% of lesions are identified within the first 2 years of life. CPAM occupying an entire lung, with a delayed adulthood presentation, is extremely rare; only 4 such occurrences have been previously described. We present a case of a 20-year-old woman diagnosed with unilateral entire lung CPAM on the basis of radiologic findings that was surgically resected via video-assisted thoracoscopic surgery.
{"title":"Unilateral Multicystic Pulmonary Disease in a Young Adult: An Unusual Diagnosis","authors":"I. Goel, P. Kaushik, Vassilis Xydis","doi":"10.1097/CPM.0000000000000297","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000297","url":null,"abstract":"Congenital pulmonary airway malformation (CPAM) is an uncommon developmental hamartomatous anomaly caused by abnormal branching of immature bronchioles with replacement of the lung by cysts/disorganized tissue. CPAMs are usually lobar or sublobar in extent, and ∼90% of lesions are identified within the first 2 years of life. CPAM occupying an entire lung, with a delayed adulthood presentation, is extremely rare; only 4 such occurrences have been previously described. We present a case of a 20-year-old woman diagnosed with unilateral entire lung CPAM on the basis of radiologic findings that was surgically resected via video-assisted thoracoscopic surgery.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"26 1","pages":"101 - 98"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000297","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47420549","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 : 2019-05-01DOI: 10.1097/CPM.0000000000000309
B. Hayward, D. Zappetti
P atients with advanced chronic obstructive pulmonary disease (COPD) have a high burden of distressing symptoms and poor quality of life. Palliative care strategies can address this; however, robust research in the use of these strategies is lacking, including studies to comprehensively assess the utilization of palliative care services in advanced COPD. This study examines the rates of formal palliative care consultation, opioid use, and long-term oxygen therapy (LTOT) for patients with advanced COPD in Ontario over a period of 10 years. The authors conducted a population-based repeated crosssectional study using health administrative data from Ontario, Canada. Health administrative databases were used to provide basic demographic data, services provided by physicians, a prescription medication for those 65 years of age or older, and the use of LTOT from 2004 to 2014, in patients with a diagnosis of COPD. Patients with advanced COPD were identified on the basis of those with ≥ 1 hospitalizations for COPD and/or the use of LTOT in those with COPD. Given that COPD is difficult to prognosticate compared with other disease groups that utilize palliative care services frequently,1 this study was unique in that it did not limit assessment of patients within their last year of life, but rather any palliative care service use during the defined study period. For this study, about 25% of patients with advanced COPD had a COPD-related hospitalization, with a mortality rate of around 18%. This study demonstrated that there was an increase in the use of formal palliative care services from 5% in 2004 to 14% in 2014 for their patient population with advanced COPD. They found that 42% of their cohort received formal palliative care services within the last 6 months of life. Although this is an important trend, it suggests that formal palliative care services are still underutilized, given the high burden of symptoms reported by patients with COPD, and the potential to expand end-of-life series to this population. Opioid use in patients with advanced COPD can alleviate severe dyspnea.2 However, numerous studies have shown relatively low use of opioids in patients with COPD even in the last year of their life, from 10% to 25% in various international studies. This has been attributed to lack of knowledge, education, and lack of guidelines. In this study, which did not define the indication for opioid prescription, 40% of patients with advanced COPD had a prescription for opioids in any given year. This is higher than has been found in other studies, but, again, it suggests underutilization, given the high reports of symptoms such as breathlessness in COPD patients. LTOT can also alleviate dyspnea and can be considered part of a palliative care strategy for patients with advanced COPD. This study found an increase in the rate of LTOT use of about 1% per year to 35% use in the final year of the study. Again, while this is an important trend, it suggests that ther
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