Pulmonology

abstract: Idiopathic pulmonary fibrosis (IPF) is a chronic interstitial lung disease of unknown etiology that leads to progressive fibrosis and respiratory failure. Patients with IPF typically present in their sixth to seventh decade of life with the insidious onset of progressive dyspnea and cough. Lung histopathology reveals the distinct lesion of usual interstitial pneumonia (UIP), and other causes of UIP, such as collagen-vascular disease, drug exposure, or occupational exposures, must be excluded. A confident clinical diagnosis of IPF can often be made without resorting to surgical lung biopsy if certain clinical features are present and a typical pattern is identified on high-resolution CT (HRCT) scanning of the thorax. Changes on HRCT scans that are typical for UIP include a predilection for peripheral and basilar lung zones with patchy involvement and sparing of more central areas, especially in upper lung zones. (J Respir Dis. 2007;28(7):283-292)

abstract: Tuberculous pericarditis, while relatively rare in the United States, is an important cause of pericardial disease in countries where tuberculosis is prevalent. Patients are most likely to present with chronic disease--effusive and/or constrictive. Those with effusive pericarditis often present with tamponade. Patients with constrictive pericarditis exhibit features of systemic and pulmonary venous congestion. An elevated level of adenosine deaminase in pericardial fluid is a good marker for tuberculosis. The presence of granulomas or case-ation necrosis in pericardial tissue confirms the diagnosis. If treatment of effusive tuberculous pericarditis is delayed, constrictive or effusive-constrictive disease usually develops, resulting in a high mortality risk. In addition to a standard antituberculosis regimen, treatment of tuberculous pericarditis may include adjuvant therapy with corticosteroids, pericardiocentesis, and/or pericardiectomy. (J Respir Dis. 2007;28(7):278-282)

A 53-year-old woman presented to the emergency department complaining of substernal chest pain that awoke her from sleep. The chest pain was associated with left shoulder numbness, radiating to her back, and was partially alleviated with sublingual nitroglycerin. During this episode, the patient had a cough productive of yellow phlegm and one instance of cough productive of 1 tbs of bright red blood.

ROCKVILLE, Md. -- The death of cystic fibrosis patient had led the FDA to alert physicians about the risk of prescribing premixed colistimethate for inhalation with a nebulizer.

TORONTO -- An investigational oil-and-water adjuvant for flu vaccines -- tested in conjunction with a vaccine against avian flu -- is safe, a researcher said here.

TORONTO -- Highly pathogenic avian flu is rarely transmitted to people and apparently never in a mild or asymptomatic form, a Thai researcher said here.

Bronchial thermoplasty is a procedure designed to reduce airway smooth muscle mass and, as a result, reduce bronchoconstriction in persons with asthma. In this procedure, radiofrequency current is applied to the walls of the central airways during a series of bronchoscopies. The results of a randomized controlled study conducted in 11 centers in 4 countries suggest that this intervention is beneficial.

Does adding an inhaled corticosteroid to treatment with a long-acting ß2-agonist help prevent exacerbations of chronic obstructive pulmonary disease (COPD)? According to Kardos and associates, the answer is yes.

LONDON -- A single oral dose of vitamin D may give the immune system enough ammunition to fight off tuberculosis for six weeks after exposure, researchers here found.

PARIS -- Cystic fibrosis patients may develop bone density deficits in the first years of life regardless of nutritional status or disease severity, researchers here found.

Nonadherence with asthma controller medication is a common problem that increases the risk of asthma-related hospitalizations and emergency department visits. Although strategies to improve adherence have often been unsuccessful, it is clear that engaging patients in asthma self-management is one of the keys.

Obesity is a well-known risk factor for many diseases. Now it looks like asthma can be added to the list. A meta-analysis that was conducted by Beuther and Sutherland indicated that being overweight is associated with a 50% increase in the incidence of asthma. The risk applies to both men and women.

HOUSTON -- A large percentage of influenza deaths are the result of disease-triggered acute myocardial infarctions, researchers here reported.

ROCKVILLE, Md. -- A vaccine against the H5N1 avian flu has been approved by the FDA.

ALBUQUERQUE, N.M. -- Moderate use of statins is associated with a sharply reduced risk of death from chronic obstructive pulmonary disease, researchers here found.

NORWICH, England -- Routine screening of newborns for cystic fibrosis is cost effective, found researchers here.

TOKYO -- There are signs that influenza B can develop resistance to two of the main antiviral drugs, according to scientists here.

Sleep complaints are common in patients with chronic obstructive pulmonary disease (COPD). Many patients complain of morning tiredness, early awakenings, difficulty in falling asleep, restlessness, and daytime sleepiness. Functional status may eventually be impaired by the resulting chronic fatigue that is compounded by dyspnea.

abstract: The mainstay of therapy for acute severe asthma includes ß2-agonists, anticholinergics, and corticosteroids. Other agents, such as leukotriene modifiers and magnesium sulfate, can be used in patients who have responded poorly to conventional therapy. Noninvasive positive pressure ventilation (NPPV) should be tried before intubation in alert, cooperative patients who have not improved with aggressive medical therapy. However, NPPV should not be attempted in patients who are rapidly deteriorating or in those who are somnolent or confused. Endotracheal intubation is recommended for airway protection or for patients who present with altered mental status or circulatory shock. Patients should be admitted to the ICU if they have difficulty in talking because of breathlessness, altered mental status, a forced expiratory volume in 1 second or peak expiratory flow rate of less than 25% of predicted, or a PaCO2 greater than 40 mm Hg after aggressive treatment in the emergency department. (J Respir Dis. 2007;28(3):113-117)

The Pneumonia Severity Index (PSI), which categorizes patients into 5 groups according to risk of short-term mortality, is used at some centers to determine which patients with community-acquired pneumonia can be safely treated as outpatients. Is this a reasonable practice? Yes, according to a multicenter study conducted in France, which found that use of the PSI in emergency departments (EDs) is associated with a greater likelihood of low-risk patients being treated as outpatients, without compromising patient safety.

The influenza vaccine not only reduces the morbidity and mortality of influenza, it also reduces the risk of death in adults hospitalized with community-acquired pneumonia (CAP). Spaude and colleagues found that this protective effect covered in-hospital all-cause mortality, even after adjustment for pneumococcal vaccination status and the presence of comorbidities.

abstract: Depression and anxiety are common comorbidities in patients with chronic obstructive pulmonary disease (COPD), and like COPD, they are often underrecognized. Both of these comorbidities can adversely affect the course of COPD. Anxiety, for example, is associated with more severe dyspnea, greater disability, and impaired functional status; it also is a significant predictor of hospitalizations for acute exacerbations of COPD. When evaluating depressive symptoms, it is important to rule out cognitive impairment, particularly in patients with severe COPD and hypoxemia. Treatment options include antidepressants and cognitive behavioral therapy. Participation in a pulmonary rehabilitation program also can help reduce anxiety and depressive symptoms in patients with COPD. (J Respir Dis. 2007;28(3):94-103)

SAN DIEGO -- City-dwelling children with asthma may miss out on allergy screening or education about avoidance of household allergens, reported New York investigators.

Results of a large prospective study

The initial assessment of acute severe asthma includes confirmation of the diagnosis and rapid assessment of mental status and degree of respiratory distress. The severity of airflow obstruction is best determined by forced expiratory volume in 1 second or peak expiratory flow rate. While inhaled ß2-agonists are the initial therapy, the combination of ipratropium and a ß2-agonist can enhance results in some patients. There also is evidence that inhaled corticosteroids can lead to a more rapid improvement in pulmonary function. (J Respir Dis. 2007;28(2):57-64)

ROCHESTER, N.Y. -- When a rapid test catches the flu, it reduces inappropriate use of antibiotics in adults, according to researchers here.

FRANKFURT, Germany -- Therapy with inhaled corticosteroids plus a long-acting bronchodilator appears to significantly improve exacerbations and other outcomes for chronic obstructive pulmonary disease (COPD), according to German researchers.

MIAMI -- Harmful algal blooms known as red tides release toxins that can leave people with asthma gasping still harder for air, reported researchers here.

PAVIA, Italy, Jan. 2 -- Chronic cough and phlegm in a young adult nearly double the risk of developing chronic obstructive pulmonary disease (COPD), researchers here said.

The authors report a case of adult-onset acute lymphoblastic leukemia (ALL) presenting with a right upper lobe infiltrate associated with acute fibrinous and organizing pneumonia (AFOP), which resolved spontaneously during the course of chemotherapy.