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New guidelines for the use of noninvasive ventilation in acute respiratory failure 1.Exacerbation of chronic obstructive pulmonary disease 2.Cardiogenic pulmonary oedema 3.de novo hypoxaemic respiratory failure 4.immunocompromised patients 5.chest trauma 6.palliation 7.post-operative care 8.weaning and post-extubation
Sleepless while you are sleeping http://epaper.newindianexpress.com/c/6294845
Bronchoscopic Lung Cryobiopsy Increases Diagnostic Confidence in the Multidisciplinary Diagnosis of Idiopathic Pulmonary Fibrosis American Journal of Respiratory and Critical Care Medicine Volume 193 Number 7 | April 1 2016 BLC is a new biopsy method that has a meaningful impact on diagnostic confidence in the multidisciplinary diagnosis of interstitial lung disease and may prove useful in the diagnosis of IPF.
Ultrasound of extravascular lung water:a new standard for pulmonary congestion. MORE B LINES SUGGESTIVE OF MORE FLUID. Regular lines suggestive of heart failure and irregular line suggestive of ILD.
Transbronchial cryobiopsy in diffuse parenchymal lung diseases Pneumothorax and bronchial bleeding which is usually controlled by using Fogarty balloon. Transbronchial cryobiopsy is a promising new technique that may become a valid alternative to surgical lung biopsy in the near feature
Multicentre evaluation of multidisciplinary team meeting agreement on diagnosis in diffuse parenchymal lung disease: a case-cohort study Agreement between MDTMs for diagnosis in diffuse lung disease is acceptable and good for a diagnosis of IPF, as validated by the non-significant greater prognostic separation of an IPF diagnosis made by MDTMs than the separation of a diagnosis made by individual clinicians or radiologists. Furthermore, MDTMs made the diagnosis of IPF with higher confidence and more frequently than did clinicians or radiologists. This difference is of particular importance, because accurate and consistent diagnoses of IPF are needed if clinical outcomes are to be optimised. Inter-multidisciplinary team agreement for a diagnosis of hypersensitivity pneumonitis is low, highlighting an urgent need for standardised diagnostic guidelines for this disease.
Fleischner Society Guideline Update 2017: Management of Solid Pulmonary Nodules. Updated 2017 Fleischner Society guidelines advise a less intensive approach to the management of most small pulmonary nodules incidentally discovered on CT scans. The Fleischner Society now recommends that solid nodules 6 mm or less in diameter in low-risk adults >35 years old generally need no further follow-up. In higher-risk patients, a follow-up CT scan should be considered optional. The recommendations apply even if multiple solid pulmonary nodules ≤6 mm are present.
Obstructive sleep apnea (OSA) is a heterogeneous disorder. If left untreated, OSA has major health, safety and economic consequences. In addition to varying levels of impairment in pharyngeal anatomy (narrow/collapsible airway), non-anatomical ‘phenotypic traits’ are also important contributors to OSA for most patients. However, the majority of existing therapies only target the anatomical cause (e.g. continuous positive airway pressure [CPAP], oral appliances, weight loss, positional therapy, and upper airway surgery). These are typically administered as monotherapy according to a trial and error management approach in which the majority of patients are first prescribed CPAP. Despite its high effectiveness, CPAP adherence remains unacceptably low and second-line therapies have variable and unpredictable efficacies. Recent advances in knowledge of the multiple causes of OSA using respiratory phenotyping techniques have identified new targets or ‘treatable traits’ to direct therapy. Identification of the traits and development of therapies that selectively target one or more of the treatable traits has the potential to personalize the management of this chronic health condition to optimize patient outcomes according to precision medicine principles.
Practical Recommendations for COPD: Evidence-Based Care The treatment of patients with chronic obstructive pulmonary disease (COPD) depends on symptoms and history of exacerbation. These elements define the treatment strategies within the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Guidelines' ABCD assessment tool • Although not taken into account in the ABCD tool, spirometry remains important for the diagnosis and assessment of airflow limitation. Bronchodilators are first-line treatment, either as a single or dual bronchodilator treatment. • The recently available combination of a long-acting beta agonist (LABA) and a long-acting muscarinic receptor antagonist (LAMA) into a single inhaler has demonstrated improvement in lung function, either in combination or with monotherapy. In the SPARK study evaluating indacaterol/glycopyrrolate vs glycopyrronium and tiotropium (LABA/LAMA vs LAMA alone) for the prevention of exacerbation in patients with COPD, the combination therapy was superior to a single bronchodilator as measured by the reduction of exacerbations. • LABA/LAMA was also shown to be superior in the ILLUMINATE study, which compared the patient-reported outcomes and the transition dyspnea index (TDI) for patients on LABA/LAMA with patients on LABA/ICS (inhaled corticosteroid). Data from multiple studies show that ICS-containing regimens can also effectively reduce exacerbation rates. Data from post-hoc analyses of clinical trials suggest that patients with high levels of blood eosinophils may respond better to ICS therapy, whereas patients with very low levels of eosinophils may not respond. ICS therapy is associated with serious side effects, such as pneumonia. In the WISDOM trial, patients who discontinued ICS experienced approximately 40 mL in forced expiratory volume over 1 second (FEV1), indicating that ICS should be withdrawn very carefully in some patients. As exacerbations are more frequent and often more severe in winter months, it is recommended to not withdraw steroids during that period Current evidence suggests that the combination of LABA/LAMA with ICS into a single inhaler will improve lung function, exacerbations, and symptoms Other treatment options besides triple therapy exist for patients who still experience exacerbations after LABA/LAMA treatment. • Roflumilast may be considered in patients with chronic bronchitis. • The use of long-term macrolides is possible in a particular profile subset of patients who have frequent exacerbations with bronchiectasis, bronchial colonization, and frequent bacterial infections.
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