Pulmonology

The emphasis in this clinically focused text is on syndromesand patient care rather than on pathogens. Among the topicscovered are antimicrobial pharmacokinetics and pharmacodynamics;head and neck infections; upper respiratory tractinfections; bronchitis and pneumonia; endocarditis; pericarditisand myocarditis; peritonitis, liver abscess, and biliary tractinfections; viral hepatitis; CNS infections; skin and soft tissueinfections; animal and human bites; osteomyelitis and infectiousarthritis; foot infections in patients with diabetes; scarletfever and toxic shock syndromes; fever of unknown origin;bacterial, viral, and protozoal diarrhea; obstetric-gynecologicinfections; urinary tract infections; sexually transmitted diseases;infectious complications of HIV infection; tuberculosis;tropical diseases; zoonoses; bioterrorism; and fungal infections.Color and black-and-white photographs, photomicrographs,CT scans, radiographs, drawings, tables, and flowchartshighlight seminal points in the text.

Q:I am trying to encourage a patient with chronicobstructive pulmonary disease (COPD) to quitsmoking. He began smoking at age 14 years and hassmoked 1 pack of cigarettes a day for 35 years. His lungfunction is moderately decreased (forced expiratoryvolume in 1 second [FEV1], 65% of predicted). What othermeasures can I recommend to help restore lung functionso that he has more stamina and less shortness ofbreath on exertion?

Chronic obstructive pulmonary disease(COPD) is the fourth leadingcause of chronic morbidity and mortalityin the United States.1 Its prevalenceand impact are increasing,and the World Bank/World HealthOrganization has projected that it willrank fifth in 2020 as a global burdenof disease.2,3 The economic and publichealth impact of COPD is staggering,because this chronic conditionrequires long-term care, frequentoffice visits, and use ofemergency department and hospitalservices. Thus, there is a pressingneed to discover new therapies thatcontrol symptoms and prevent diseaseprogression.

Q:Is there a role for inhaled corticosteroids in chronic obstructivepulmonary disease (COPD)?

PHILADELPHIA -- Asthma mortality rates are declining worldwide, largely due to increased use of inhaled corticosteroids to manage the disease. That was the conclusion of an international group of researchers, who presented data on world trends at a 2006 meeting here.

HOUSTON -- After a plaque of scary headlines, the news of a potential pandemic avian flu has dropped off the front pages. But virologists believe the threat is waiting in the wings.

KINGSTON, Ontario, Dec. 20 -- For critically ill patients on mechanical ventilation, bronchoalveolar lavage and endotracheal aspiration appear to be equally effective when diagnosing pneumonia, said researchers here.

HOUSTON -- Cromolyn, an old-line asthma and allergy drug, has shown a marked effect on the progress of pancreatic cancer - at least in mice.

ANN ARBOR, Mich. -- For seasonal flu strains that were slightly different than predicted, the traditional killed-virus vaccine in 2004-2005 was about 75% effective, while a live attenuated-virus nasal spray was less effective, researchers reported.

ANN ARBOR, Mich. -- For seasonal flu strains that were slightly different than predicted, the traditional killed-virus vaccine in 2004-2005 was about 75% effective, while a live attenuated-virus nasal spray was less effective, researchers reported.

The goals of therapy in chronic obstructive pulmonary disease are to ameliorate symptoms, improve daily function, preserve lung function, identify and reduce exacerbations and, if possible, decrease mortality. A comprehensiveapproach that includes prevention, early identification, and pharmacotherapy-and oxygen therapy, pulmonary rehabilitation, and/or surgery when appropriate-can optimize patient outcomes.

Although the estimates of prevalence vary, there is convincing evidence that patients with chronic obstructive pulmonary disease (COPD) are at increased risk for depression. Moreover, depression has been associated with diminished functional status, increased symptoms, and increased mortality in patients with COPD. Encouraging news comes from Nguyen and Carrieri-Kohlman, who report that a dyspnea self-management program that includes exercise can reduce both dyspnea and depressed mood in these patients.

NPPV should be considered theventilatory modality of first choicein patients presenting to an acutecare hospital with an exacerbationof COPD. This is based on the findingsof multiple randomized controlledtrials as well as meta-analyses.These have shown that NPPVused in such patients brings about amore rapid improvement in dyspnea,vital signs, and PaCO2 thandoes oxygen therapy with standardmedical treatment. Use of NPPV resultsin significant reductions in theneed for intubation, morbidity andmortality rates, and in some studies,the length of hospital stay. These latterbenefits are unquestionably relatedto the avoidance of the complicationsof intubation, includingnosocomial infections, that increasein occurrence as the duration of intubationbecomes prolonged.

Increasing evidence demonstrates that adolescents with asthma are at greater risk for anxiety and depression. However, few studies have investigated the association of psychological disorders with asthma symptoms, an important factor in evaluating asthma treatment. Now the results of a large population-based study of adolescents with asthma confirm that anxiety and depression are highly associated with increased asthma symptoms.

Abstract: Because of the impact of allergen exposure on asthma control, all patients with asthma should be evaluated for allergic sensitization. Such patients can be referred to an allergist for evaluation, or radioallergosorbent tests can be ordered by the primary care provider. The major groups of aeroallergens that can trigger asthma attacks include furred-pet, dust mite, cockroach, rodent, mold, and pollen allergens. When assessing a patient's exposure history, remember that furred-pet allergens are found not just in the home, but in other settings, such as schools, and these allergens are passively transferred from one environment to another. Allergen avoidance measures are essential to the management of asthma in sensitized patients and can significantly improve asthma control. First-line dust mite control measures include installing allergen-proof mattress and pillow encasements, washing all bedding every 1 to 2 weeks in hot water, removing stuffed toys, vacuuming and dusting regularly, and reducing indoor relative humidity. (J Respir Dis. 2006;27(12):511-526)

The association between asthma and pneumococcal disease has been suspected by many clinicians; however, formal investigations confirming an increased risk of pneumococcal disease in patients with asthma are rare.

ATLANTA -- The seasonal flu season is here, but tell that to the viruses. The quixotic little pathogens haven't yet flexed their muscles in earnest, according to the CDC.

PHILADELPHIA -- Teens with asthma are more likely to be depressed and to smoke than their non-asthmatic peers, according to a preliminary analysis of CDC survey data.

TORONTO -- A flu shot appears to increase the relative risk of Guillain-Barré syndrome by 45%, according to researchers here.

The 2006-2007 influenza season is upon us. Influenza epidemics have been associated with an average of about 36,000 deaths per year in the United States from 1990 to 1999.1 In July of this year, the Advisory Committee on Immunization Practices (ACIP) updated its recommendations for the prevention and control of influenza.2

Although the overall rates of asthma-related hospitalization and death are about 2.5 to 5 times higher among black than white patients, it has not been known whether hospital deaths also are increased in black patients with asthma exacerbations. Investigators from Johns Hopkins who studied this issue found there were no significant race differences in hospital deaths.

JACKSONVILLE, Fla. -- Acid reflux atop chronic obstructive pulmonary disease is associated with twice as many COPD exacerbations a year compared with patients without acid reflux, researchers here said.

When a patient with chronic obstructive pulmonary disease (COPD) presents with what appears to be an acute exacerbation, you should consider the possibility of pulmonary embolism (PE). This is the message conveyed by a prospective cohort study in France.

The authors report the incidental finding of a persistent left superior vena cava (PLSVC) during the routine placement of a left subclavian central line in an elderly man with acute renal failure.

Can early intervention with inhaled corticosteroids help prevent irreversible lung function decline in patients with asthma? Yes, according to results of the international Inhaled Steroid Treatment as Regular Therapy in Early Asthma (START) study.