Is bronchoalveolar lavage useful in the diagnosis and management of interstitial lung disease? Meyer and Raghu believe so (although their manuscript title suggests they’re not 100% sure). They explain why in the October ERJ. They argue that if interpreted in the right clinical context, certain bronchoalveolar lavage findings can help cinch the diagnosis of ILD: Lymphocytes >= 25%: [... read more]
Other than referring early to a lung transplant center, there are no strong expert recommendations on how to help patients with idiopathic pulmonary fibrosis (IPF). Trials of therapies have been a trail of tears. So you might think, since there are no treatments, it shouldn’t matter who’s doing the non-treating. But it just might, say [... read more]
Among people with idiopathic pulmonary fibrosis, survival varies widely and thus far, largely unpredictably. du Bois, Talmadge King et al used data from 2 large clinical trials on IPF (n=1,156) to create a useful model for predicting survival. They culled the variables to those that were both robustly predictive and also readily obtainable: age, percent [... read more]
This month’s Current Opinion in Pulmonary Medicine has a section each on sarcoidosis, interstitial lung disease, and pulmonary vascular disease, mainly DVT/PE. Curr Opin Pulm Med 2011;17:297-402.
Lung fibrosis is partially mediated by tyrosine kinase pathways. BIBF 1120 is a tyrosine kinase inhibitor that targets vascular endothelial growth factor receptor (VEGFR), fibroblast growth factor receptor (FGFR) and platelet-derived growth factor receptor (PDGFR) — all receptors known to be involved in lung fibrosis. Supported by Boehringer Ingelheim, Richeldi et al randomized 432 patients with [... read more]
Let’s agree that the time-honored and most straightforward way to interpret an indeterminate test result is to simply pronounce that it confirms what you thought already. The more “messy” and imprecise a test — say, the 6-minute walk distance — the better suited it is for this purpose. If you want to get more reality-based [... read more]
Walker et al give us a nice picture and high-yield tutorial on the reversed halo sign, in this case from cryptogenic organizing pneumonia: J Thorac Imaging 2011;26:w80. (FREE)
400,000 people breathed the dust and smoke at Ground Zero after the World Trade Center attacks. Friedman et al identified 180 people (mostly residents) who had persistent respiratory symptoms after 9/11. (All were never-smokers.) They were matched with 473 controls who were symptom-free. More cases had abnormal spirometry (19% vs 11%), although most were normal. [... read more]
September’s Current Opinion in Pulmonary Medicine has 4-5 review articles each on sarcoidosis (how to handle calcium problems; cardiac sarcoid); interstitial lung disease (biologics for connective-tissue disease related ILD; LAM therapies; stem cell therapy for pulmonary fibrosis), and pulmonary vascular disease. Curr Opin Pulm Med 2011;17.
Unimpressed by the unimpressive results of the CAPACITY trials testing pirfenidone for idiopathic pulmonary fibrosis, the FDA bucked its advisory panel (which had recommended approval) and insisted on another randomized trial in order to reconsider the drug. In July 2011 InterMune started enrollment for ASCEND, which plans to provide results on pirfenidone vs. placebo in [... read more]
King et al report a series of 80 otherwise healthy young vets who failed a 2-mile run fitness test due to dyspnea at Fort Campbell, KY. Many had been exposed to sulfur fires or other inhalational exposures. Among 49 who underwent open lung biopsy, 38 had constrictive bronchiolitis, an extremely rare condition in otherwise healthy [... read more]
A retrospective review of 521 patients in one Virginia center from 2000-2009, by Nathan SD et al. CHEST 2011;140:221-229
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia. Nassar AA et al. AJRCCM 2011;184:8-16.
Alveolar capillary dysplasia. Bishop NB et al. AJRCCM 2011;184:172-179.
Pulmonary alveolar proteinosis. Borie R et al, Eur Resp Rev 2011;20:98-107.
Follow-up and nonpharmacological management of the idiopathic pulmonary fibrosis patient. Egan JJ, Eur Resp Rev 2011;20:114-117.
After 25 years of declines in coal workers’ pneumoconiosis (thanks to federal regulation of tolerable concentrations of coal dust and radiographic surveillance of miners), CWP and progressive massive fibrosis have been on the upswing since 2001, killing or disabling dozens of relatively young miners. Wade et al describe the trend in a cohort of 138 [... read more]
Pulmonary rehabilitation, realities in clinical practice. Birnbaum S, CHEST 2011;139:1498-1502. Having trouble finding a pulmonary rehab program to refer your COPD patient into? That may be because in 2011, according to Mr. Birnbaum, Medicare paid outpatient centers $28 per rehabilitation session, per patient.
Due to its characteristic brain tumors causing intellectual delay and seizures, TSC-LAM usually presents in childhood. Seibert et al report a series of 79 adult women with TSC-LAM, 45 of whom were diagnosed in adulthood. 15 did not meet diagnostic criteria until after age 18. Ann Intern Med 2011;154:806-813.
Lore had it that viruses cause exacerbations of idiopathic pulmonary fibrosis. Wootton et al collected BAL fluid from 43 people during IPF exacerbations. Viruses were present in 4. The exception was “torque teno virus,” present in 12 — but this virus was also present in ~25% of acute lung injury patients’ BALs used as controls. [... read more]