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Journal Of Respiratory Diseases

Journal Of Respiratory Diseases

ABSTRACT: In general, the management of invasive pulmonary
aspergillosis is based on antifungal therapy and reversal of immunosuppression.
Voriconazole is the preferred treatment in
most cases. Liposomal preparations of amphotericin B, caspofungin,
and posaconazole are alternatives in patients who
cannot tolerate voriconazole or have refractory aspergillosis.
Prophylaxis in high-risk patients has gained popularity with
the availability of oral extended-spectrum azoles; posaconazole
is approved for prophylaxis in patients with acute leukemia,
myelodysplastic syndrome, and graft versus host disease.
(J Respir Dis. 2008;29(11):429-434)

A 71-year-old man who had received a diagnosis of emphysema 12 years ago was referred by his primary care physician to the pulmonary clinic. His symptoms were well controlled until a few months ago, when he complained of mild shortness of breath on physical activity. However, the shortness of breath worsened and became a significant limiting factor. He also had a persistent dry cough.

Death caused by asthma is not traditionally thought to be especially common, but it is important to note that asthma often plays a contributing and probably unrecognized role even if it is not often listed as the cause of death on a death certificate. Because early response to asthma exacerbations can make a crucial difference, it is important to develop patient action plans in the outpatient setting well before an attack occurs. However, since busy clinicians must prioritize their educational efforts, identifying who is most at risk for death from asthma is all the more important.

I read with interest the Chest Film Clinic on pneumomediastinum by Weinstock, Boiselle, and Roberts in the August issue (What caused this woman's pneumomediastinum? J Respir Dis. 2008;29:314-317). In the discussion of the differential diagnosis, the authors did not mention the occurrence of mediastinal emphysema in diabetic ketoacidosis, which was described in 4 patients by Beigelman and associates1 in 1969.

To what extent are patients with obstructive sleep apnea syndrome (OSAS) at increased risk for postoperative complications? Are there any specific interventions that reduce the risks?

Two studies—one conducted in Philadelphia, and the other in San Francisco—demonstrate that crowding in the emergency department (ED) is associated with a delay in providing antibiotic therapy for patients with pneumonia.

ABSTRACT: The diagnosis of asthma in older persons may be
complicated by a number of factors, including atypical presentations
and comorbid conditions, such as chronic obstructive
pulmonary disease and congestive heart failure (CHF). A
high index of suspicion for the diagnosis of asthma is warranted
in patients with isolated dyspnea or cough. The diagnosis
should be based on demonstration of reversible airway
obstruction on pulmonary function tests. Additional tests that
may be useful in the initial evaluation include chest radiography,
arterial blood gas analysis, and standard electrocardiography.
CT may help exclude pulmonary embolism and certain
neoplasms that can masquerade as asthma. High-resolution
CT scans are valuable when pulmonary function test
results are consistent with interstitial lung disease. When the
diagnosis is uncertain, measurement of brain natriuretic peptide
can help distinguish between obstructive lung disease and
CHF. (J Respir Dis. 2008;29(10):391-396)

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