Pulmonary alveolar proteinosis occurs as an idiopathic disease, or can be secondary to other conditions (HIV, silica exposure, infections, blood cancers). In the idiopathic form, autoantibodies to GM-CSF are thought to be responsible. Rituximab (a chimeric mouse-human monoclonal antibody binding CD-20) depletes human B-cells, reducing antibody production. Autoantibodies are particularly reduced after rituximab administration, leading [… read more]
Please also see the newer post describing the final results of PANTHER-IPF, published in NEJM 2012. PANTHER-IPF, a landmark clinical trial testing commonly used therapies for idiopathic pulmonary fibrosis, was stopped in October 2011 for apparent harm caused to patients by prednisone and azathioprine. This news was released back then, but maybe you missed it, as [… read more]
Air Travel for Patients with Lung Disease (BTS Recommendations) Some interesting facts, figures, and recommendations on air travel for those with chronic lung disease, thanks to Ahmedzai et al who produced this 32 page document for the British Thoracic Society: At 8,000 feet in a commercial aircraft, you’re breathing 15% O2, and normal people’s SpO2 [… read more]
Noble et al report results of two Phase III placebo-controlled trials in N. America and Europe, with 779 patients total. In one trial, pirfenidone reduced FVC decline by ~4% at 72 weeks; in the other, it did not; pooling all the data, pirfenidone reduced FVC decline by 2.5% compared to placebo. There were abundant mild [… read more]
Duke’s Momen Wahidi and other luminaries bring you a consensus statement on use of peri-procedure medications during bronchoscopy. I’m assuming you’ve done a few already, so here are some highlights (with slight liberties in paraphrasing): Use topical anesthesia as well as moderate sedation in all patients, unless there are contraindications or you practice at a secret CIA prison. [… read more]
Talc pleurodesis is 90-95% effective at prevention of recurrent primary spontaneous pneumothorax. However, there have been reports of ARDS occurring after talc pleurodesis, mostly in patients with malignant pleural effusions, raising concerns over its use. Bridevaux et al report results of talc pleurodesis on 418 patients with primary spontaneous pneumothorax (PSP) at nine centers in Europe and [… read more]
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]
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]
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)
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
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.
Lung vasculitis and alveolar hemorrhage. Ten articles in 103 pages. Semin Resp Crit Care Med 2011;32:243-346. Review.