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]
At least 7 papers have reported an increase in risk of death after lung transplantation, mostly in the first year. For this reason, obesity is a soft contraindication to lung transplantation at many centers. David Lederer et al sought to parse out how much of that signal might be due to primary graft dysfunction, and [... 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]
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.