Bronchoscopy is often the initial diagnostic procedure performed in patients with pulmonary lesions suspicious for lung cancer. A bronchial genomic classifier was previously validated to identify patients at low risk for lung cancer after an inconclusive bronchoscopy. In this study, we evaluate the potential of the classifier to reduce invasive procedure utilization in patients with suspected lung cancer.
Chest x-ray (CXR) is the test of choice for diagnosing pneumonia. Lung ultrasound (LUS) has been shown to be accurate for diagnosing pneumonia in children and may be an alternative to CXR. Our objective was to determine the feasibility and safety of substituting LUS for CXR when evaluating children with suspected pneumonia.
We update recommendations on 12 topics that were in the 9th edition of these guidelines, and address 3 new topics.
The global burden of sepsis is estimated as 15 to 19 million cases annually with a mortality rate approaching 60% in low income countries.
Over a quarter of the US population qualify as excessive alcohol consumers. Alcohol use impacts several lung diseases and heavy consumption has been associated with poor clinical outcomes. The fractional excretion of exhaled nitric oxide (FeNO) has clinical implications in multiple airway diseases. We hypothesized that excessive alcohol intake is associated with lower FeNO levels.
Problems with the use of inhalers by patients were noted shortly after the launch of the metered dose inhaler (MDI) and persist today. We aimed to assess the most common errors in inhaler use over the last 40 years in patients treated with MDI or dry powder inhalers (DPI).
Parental smoking is known to worsen asthma symptoms in children and make them refractory to asthma treatment, but the molecular mechanism is unclear. Recently, oxidative stress from tobacco smoke has been reported to impair histone deacetylase-2 (HDAC2) via phosphoinositide-3-kinase (PI3K)/Akt activation and thus to reduce corticosteroid sensitivity. The aim of this study is to investigate passive smoking dependent molecular abnormalities in alveolar macrophages by comparing passive smoke exposed children and non-passive smoke exposed children with uncontrolled severe asthma.
We performed a systematic review and meta-analysis of short- versus long-duration antibiotic regimens for ventilator-associated pneumonia(VAP).
Pulmonary aspergillomas may cause life-threatening hemoptysis. The treatment of this condition is problematic because poor pulmonary function often precludes definitive surgical resection.
ABSTRACT BACKGROUND: Disease progression in chronic obstructive pulmonary disease (COPD) is associated with decline in exercise performance over time. We assessed whether tiotropium might mitigate this by determining its effect on treadmill endurance time (ET) over 2 years. METHODS: Randomized, double-blind, placebo-controlled trial of tiotropium 18 µg daily in patients with COPD (forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) < 70%; postbronchodilator FEV1 < 65%). Primary endpoint: ET at 90% of baseline maximum work rate at 96 weeks. Secondary endpoints: ET at other visits, ET by smoking status, spirometry, St George Respiratory Questionnaire (SGRQ). RESULTS: 519 patients randomized (tiotropium 260, placebo 259), mean 65 years, 77% men, 34% continuing smokers, FEV1 1.25 L (44% predicted). Significantly more patients discontinued placebo: hazard ratio (95% CI) 0.61 (0.44, 0.83). Baseline ET was 301 s (improvement tiotropium/placebo: 13% overall, P = 0.009; 18% at 48 weeks, P = 0.004; 13% at 96 weeks, P = 0.106). In patients with baseline ET between 2-10 minutes (n = 404), improvement at 96 weeks was 19% (P = 0.04). Current smokers had higher ET with tiotropium vs placebo (P = 0.018). FEV1/FVC improved with tiotropium (P < 0.01). SGRQ total score at 96 weeks improved with tiotropium vs placebo by 4.03 units (P = 0.007). CONCLUSIONS: Treadmill ET was numerically greater over 2 years with tiotropium vs placebo. However, 96-week difference was not statistically significant. Spirometry and health status also improved with tiotropium over 2 years, attesting to the benefits of long-acting bronchodilator therapy.ClinicalTrials.gov: NCT00525512.