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Comprehensive and Individualized Patient Care in Idiopathic Pulmonary Fibrosis: Refining Approaches to Diagnosis, Prognosis, and Treatment Implement multidisciplinary clinical and imaging approaches to achieve more timely and accurate diagnosis of IPF • Develop IPF treatment strategies based on key guideline recommendations and examine the supporting clinical trial data • Describe key elements of an individualized approach to IPF treatment that involves shared decision-making Standard immunosuppressive therapy is no longer indicated, whereas pirfenidone, nintedanib, and antacid therapy are all conditionally recommended for use. Individualizing treatment is important in light of potential improved adherence to both drug therapy and health behaviors. An early referral to an interstitial lung disease center offers the advantages of comprehensive diagnostic and disease-management expertise, potential enrollment in a clinical trial, and evaluation for transplantation.
Obstructive Sleep Apnea and Diabetes Obstructive sleep apnea (OSA) is a chronic treatable sleep disorder and a frequent comorbidity in patients with type 2 diabetes. Cardinal features of OSA, including intermittent hypoxemia and sleep fragmentation, have been linked to abnormal glucose metabolism. The relationship between OSA and type 2 diabetes may be bidirectional in nature given that diabetic neuropathy can affect central control of respiration and upper airway neural reflexes promoting sleep-disordered breathing. Despite the strong association between OSA and type 2 diabetes, the effect of treatment with continuous positive airway pressure (CPAP) on markers of glucose metabolism has been conflicting. Variability with CPAP adherence may be one of the key factors behind these conflicting results. Lastly, accumulated data suggests an association between OSA and type 1 diabetes as well as gestational diabetes.
Postoperative Pulmonary Complications Br J Anaesth. 2017;118(3):317-334. Changes to the respiratory system occur immediately on induction of general anaesthesia: respiratory drive and muscle function are altered, lung volumes reduced, and atelectasis develops in > 75% of patients receiving a neuromuscular blocking drug..The respiratory system may take 6 weeks to return to its preoperative state after general anaesthesia for major surgery. clinicians should be aware of non-modifiable and modifiable factors in order to recognize those at risk and optimize their care.Preventative measures include preoperative optimization of co-morbidities, smoking cessation, and correction of anaemia, in addition to intraoperative protective ventilation strategies and appropriate management of neuromuscular blocking drugs. Protective ventilation includes low tidal volumes, which must be calculated according to the patient's ideal body weight. the most beneficial level of PEEP is required,
COPD (Chronic obstructive pulmonary diseases or chronic bronchitis) Assessment of the risk of death in this patients depend on their BODE Index B stand for BMI, O- Obstruction depending on FEV1, D - Shortness of breath OR dyspnea using MMRC scale , E - Exercise capacity, measured by 6 minutes walk test 6MWT.This index calculated using a scale of 0 to 3 for each parameter, depending on severity. except BMI scale different < 21 is 0 and more than >21 is 1. BODE score of 7 to 10 falls in the higher chance of mortality. Other factors have also been associated with increased moribidity and mortality in COPD , For example : acute exacerbation of COPD, Hospitalization, cardiac comorbidities Survival benefit are smoking cessation and lung volume reduction surgery in selected patients .Oxygen is beneficial who are hypoxemic on room air. None of the medications consistently demonstrated to prolong life.
Risk factors for lung cancer worldwide Tobacco smoking is the major determinant of lung cancer risk; genetics, occupation, pollution, poor diet also contribute.
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