摘要:

&NA;Patients with bronchiectasis often experience daily copious sputum production, paroxysms of chest discomfort and breathlessness, episodic bronchopulmonary infection, and hemoptysis. The diagnosis is made on the basis of historical and radiographic information; a CT scan of the chest displays characteristic findings of thickened and dilated airways, sometimes with cystic, fluid‐containing sacs. Causes of bronchiectasis include infection, structural lung abnormalities, and cystic fibrosis, which accounts for approximately one half of recognized cases. Treatment involves targeting the underlying disorder when possible, administering antibiotics for infectious exacerbations, and occasionally resecting an isolated segment or performing bilateral lung transplantation.Clin Pulm Med 2000;7(5):223‐230

ISSN:1068-0640    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Rehabilitation programs for patients with chronic lung diseases are well established and have been increasingly incorporated into recommended disease management plans for such patients. Key elements of rehabilitation include the use of a multidisciplinary approach to care, focus on the individual patient, and attention to emotional and social aspects, in addition to physical aspects of health. Appropriate candidates are symptomatic patients with chronic lung disease who are aware of their disability and motivated to participate actively in their own health care. Traditionally applied to patients with chronic obstructive pulmonary disease, pulmonary rehabilitation has been useful for patients with many other types of chronic lung diseases as well. Program components include a careful patient evaluation, education, instruction in respiratory and chest physiotherapy techniques, exercise training, and psychosocial support. A growing body of literature from clinical trials demonstrates the benefits of pulmonary rehabilitation, including improvement in symptoms, exercise tolerance, and quality of life and reduction in the use of health care resources. Pulmonary rehabilitation has also been included increasingly as an adjunct to surgical programs including lung transplantation, lung volume reduction surgery, and lung resection.Clin Pulm Med 2000;7(5):231‐238

ISSN:1068-0640    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Recent advances in nontuberculous mycobacterial (NTM) disease are perhaps less dramatic than those made in the early 1990s, but important developments continue to emerge. The American Thoracic Society published a comprehensive review of NTM disease that includes new diagnostic guidelines for NTM pulmonary disease. These diagnostic guidelines have limitations but help ensure that with long‐term follow‐up, patients with indolent disease are correctly identified. The pathogenesis ofMycobacterium aviumcomplex (MAC) lung disease is poorly understood, but some investigation has begun, especially for nodular/bronchiectatic MAC disease. No genetic predisposition or specific immune deficiency has been identified so far. The optimal treatment for patients with MAC lung disease remains to be determined; however, daily and intermittent regimens that contain a macrolide (clarithromycin or azithromycin) are most effective. Unfortunately, drug‐related side effects are still a significant and limiting problem. Surgery is important for selected patients with MAC lung disease but is associated with frequent complications. Treatment and prophylaxis of disseminated MAC disease in patients with AIDS are still quite effective with macrolide‐containing regimens. Patients with disseminated MAC disease respond well microbiologically to regimens that include only clarithromycin and ethambutol (without rifabutin), although the incidence of clarithromycin resistance is higher with this two‐drug regimen. It is not clear if the two‐drug regimen would be as effective in patients with pulmonary MAC disease or if it would prevent the emergence of clarithromycin‐resistant MAC isolates.Clin Pulm Med 2000;7(5):239‐244

ISSN:1068-0640    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Diffuse panbronchiolitis (DPB) is a recently recognized idiopathic chronic progressive suppurative and obstructive airway disease, which has distinct pathologic and radiologic features. DPB typically presents with wheezing, chronic bronchial sepsis, and often rapidly progresses to respiratory failure and death if untreated. Many patients with early DPB haveHaemophilus influenzaeisolated from their sputum, which is replaced by the repeated isolation ofPseudomonas aeruginosain more advanced disease. Crackles and wheezes are generally detected on auscultation of the chest. Typically, chest radiographs and high‐resolution CT show the presence of small nodules (up to 2 mm) that are diffuse, symmetric, and predominantly basal in the lungs. There is also hyperinflation of the lung fields consistent with small airway obstruction, and bronchiectasis is also present in advanced disease. Untreated patients have 5‐ and 10‐year survival rates of 42% and 25.4%, respectively. Administration of long‐term low‐dose erythromycin improves survival, symptoms, lung function parameters, arterial oxygen tension, and imaging findings in most patients. Long‐term administration of erythromycin (600 mg daily) improves the 10‐year survival rate of DPB patients who haveP aeruginosainfection from 12.4% to >90%. DBP is likely to be underdiagnosed outside Japan, and affected patients might therefore miss the opportunity to receive a highly efficacious treatment. Pulmonologists should actively exclude this treatable condition in patients with chronic bronchial sepsis and obstructive lung diseases.Clin Pulm Med 2000;7(5):245‐252

ISSN:1068-0640    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Psychological processes can produce continuous changes in respiratory function over time in response to environmental and anticipated demands. Demands for active coping tend to produce bronchodilation as well as increases in ventilation. Such increases also occur in certain anxiety states, where the fight‐or‐flight reflex is elicited. However, stress‐related bronchoconstriction can occur, probably mediated by parasympathetic rebound effects. In the case of individuals with asthma, these changes can be clinically significant, and direct pulmonary effects of some psychological interventions can be useful adjuncts to treatment of this disorder. There is some evidence that patients with asthma may show individual response stereotypy, with a characteristic parasympathetic response to stress. The effects of psychological stress and relaxation on inflammatory processes in asthma may work synergistically with autonomic processes. The immediate effects of relaxation may be a parasympathetically mediated bronchocon‐striction among patients with asthma, although the longer‐term effects suggest better pulmonary function, perhaps due to decreased autonomic lability. Slow breathing, as caused by biofeedback training to increase the amplitude of respiratory sinus arrhythmia, may produce immediate as well as longer‐term improvements in pulmonary function among patients with asthma, although this method requires further clinical evaluation.Clin Pulm Med 2000;7(5):253‐258

ISSN:1068-0640    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Increasing financial pressures on the health care delivery system are making the delivery of cost‐effective patient care imperative. Although reimbursement is important in the continued operation of any health care facility, its primary mission must be to deliver quality care. Patients who require long‐term ventilation have specific issues that must be addressed in a systematic fashion to ensure appropriate and timely interventions. Clinical issues involving respiratory therapy, nutritional support, rehabilitation, and pharmaceutical use are addressed. Ethical issues, legal issues, social issues and operational issues such as unit design, reimbursement, and use of an electronic medical record are also addressed in this review.Clin Pulm Med 2000;7(5):259‐269

ISSN:1068-0640    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Drowning is a major cause of accidental deaths, especially in children. Near‐drowning, defined as survival, at least temporarily, after suffocation by submersion, continues to be an important source of morbidity related to the length of the hypoxic‐ischemic insult. Efforts should be focused on the development of a rapid response system. Cardiorespiratory support and protection against hypothermia by prehospitalization providers can improve the condition of near‐drowning victims and the chances for neurologically intact survival. A systematic and aggressive approach needs to be followed at the emergency department. Vital signs, oxygenation, and chest radiographs should be assessed, and at least 4 to 6 hours of observation are warranted, even for asymptomatic patients. Supportive measures including monitoring cardiorespiratory and neurologic status and attention to the metabolic condition should be continued at the critical care area. Complications such as acute respiratory distress syndrome, nosocomial infections, and secondary brain damage are still common. The mortality rate is high in patients with circulatory arrest on admission but low in all other patients. Despite aggressive care, neurologic injury with long‐term sequelae remains the major problem in these patients. The most successful management of these accidents is prevention.Clin Pulm Med 2000;7(5):270‐275

ISSN:1068-0640    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:1068-0640    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Frontal and lateral chest radiographs (A and B) were obtained in a 78‐year‐old woman with chronic cough and absence of crackles on auscultation of the right bases. She also complained of right upper quadrant abdominal pain and had fever. The chest radiograph showed a triangular heterogeneous opacity in the right lung bases, located posteriorly on the lateral view. A CT scan of the chest was performed to rule out a pulmonary abscess or an atelectasis in the right lower lobe (C and D). The CT scan showed a huge mass in the right posterior hemithorax, containing fat, a large air‐fluid level, and four heterogeneous, focal gas collections. What is your diagnosis?

ISSN:1068-0640    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:1068-0640    

出版商:OVID    

年代:2000

数据来源: OVID