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'standard immunosuppressive therapy'
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The development of biomarker-driven targeted therapy has resulted in substantial benefits for patients with non–small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutations, and rearrangements involving the anaplastic lymphoma kinase (ALK) gene or the ROS1 gene. For patients with EGFR-mutant NSCLC EGFR tyrosine kinase inhibitors (eg, gefitinib, erlotinib, and afatinib) have a superior objective response rate and progression-free survival compared with chemotherapy in the first-line setting. For patients who have disease progression on EGFR tyrosine kinase inhibitor and with NSCLC with an EGFR T790M mutation osimertinib has demonstrated a superior response rate and progression-free survival compared with chemotherapy in the second-line setting.4 For patients with ALK rearrangements ALK tyrosine kinase inhibitors (eg, crizotinib, ceritinib) have a superior response rate and progression-free survival compared with chemotherapy in the first-line setting, and for patients who experience disease progression, ceritinib and alectinib have demonstrated clinically relevant response rates and progression-free survival..For patients with ROS1 rearrangements, targeted therapy, is associated with a higher response rate and longer progression-free survival than has been observed with chemotherapy. These molecular alterations are more common in NSCLC with adenocarcinoma histology and in the minority of patients with a light smoking or never smoking history. The success of these targeted therapies in molecularly defined subsets of NSCLC made the development of targeted therapies and identification of predictive biomarkers a focus of thoracic oncology research. Routine molecular testing is now the standard of care for patients with NSCLC with adenocarcinoma histology
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.
Oxygen therapy for interstitial lung disease: a systematic review Eur Respir Rev 2017; 26: 160080 This systematic review showed no effects of oxygen therapy on dyspnoea during exercise in ILD, although exercise capacity was increased.
Targeted therapy in the management of severe asthma patients High T2 High esinophil count and HIGH igE They are responsive to corticosteriods and biological Low T2 Normal esnophil count and normal IgE THEY ARE POOR TO STERIODS AND POOR RESPONSE TO BIOLOGICALS
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.
Personalised Medicine for Asthma and Chronic Obstructive Pulmonary Disease Asthma and chronic obstructive pulmonary disease (COPD) are prevalent condition sboth significant heterogeneity within each of these conditions and additionally significant overlap in many of the clinical and inflammatory features useful clinical and immunological biomarkers which inform about prognosis and response to therapy have emerged in both asthma and COPD. These biomarkers will allow both better targeting of existing treatments and the identification of those patients who will respond to novel therapies which are now becoming available Delivery of precision medicine in airways disease is now feasible and is a core component of a personalised healthcare delivery in asthma and COPD
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.
Use of Biological Agents in Asthma: Despite advances in asthma initiatives, there continues to be a large population of patients with severe asthma whose condition remains uncontrolled despite the use of inhaled combination corticosteroids and long-acting beta-agonist treatment. For this population, which may include as many as one-third of all patients with asthma, biological therapy is often a treatment consideration in specialist clinics.
A definitive diagnosis of pleural TB depends on the isolation of Mycobacterium tuberculosis in the sputum, pleural fluid or pleural biopsy specimens, or the demonstration of caseating granulomas in the parietal pleura. However, lymphocytic exudades with a high ADA content (>35–40 U/L) are generally accepted as tuberculous in the correct clinical context. ● When the cause of a pleural effusion remains obscure after the standard initial workup, which may eventually include pleural biopsy, medical history and all available diagnostic examinations should be revisited. Most of these effusions will resolve spontaneously
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