A 43-year-old African American woman presented to the emergency department with severe dyspnea, wheeze, and cough productive of white sputum. Three years earlier, she had been given a diagnosis of asthma based on symptoms of wheeze and cough; her treatment regimen included intermittent use of albuterol.
A 61-year-old man with arthritis and an 80-pack-year smoking history presented with fever, dyspnea, and productive cough of a week’s duration that did not respond to outpatient treatment with levofloxacin.
A 6-month-old boy has a 1-week history of dry cough that worsens at night. He has been wheezing intermittently for the past month. A 2-year-old girl has had severe nighttime cough, congestion, and fever for 2 days. She recently recovered from a respiratory illness of 1 month's duration. Chest radiographs of both patients are shown… Read More
Find out the pathological distinction between this 43-year-old African American woman's ultimate diagnosis and a diagnosis of desquamative interstitial pneumonia. Read More
Patients with asthma may be reluctant to exercise for fear of triggering an attack. You can reassure them that adequate control can allow them to participate in almost any physical activity they wish. Recommendations from the NIH offer guidance on prevention of exercise-induced bronchospasm… Read More
A 61-year-old man was admitted with the diagnosis of right lower lobe (RLL) pneumonia on the basis of RLL consolidation on his radiograph. He was treated with intravenous ceftriaxone and azithromycin. However, there was no improvement in his symptoms... Read More
PEDIATRIC SPIROMETRY OVERVIEW
Prof. Dominic Fitzgerald, a pediatric respiratory and sleep physician, reviews the basics about spirometry, and explains its use in children.
Among the information of interest to primary care: Asymptomatic smokers may show signs of COPD, and what to do about it. How to treat obstructive sleep apnea as effectively as a sleep center. And things you may not know about inhalers. More »
A panel of physiological markers of respiratory function adds significantly to the predictive value of clinical prognostic factors such as forced expiratory volume and age. More »
Despite widespread concern about the use of these drugs for patients with asthma and allergies, a review of the evidence shows that (used as recommended) there is very little risk from introducing a steroid into the upper respiratory system on a fairly regular basis, even for a child. More »
Amish school children have a lower prevalence of allergies and asthma, especially if they've had plenty of exposure to cows. A study of European farm families suggests the reason. More »
As one of 17 medical organizations collaborating in the nationwide "Choosing Wisely" campaign to help doctors and patients work together to reduce unwarranted testing, the American Academy of Allergy and Immunology has made five suggested topics for discussion. Your patients with asthma and... More »
The test can improve outcomes for COPD, but a new review outlines revised standards that call for going beyond spirometry to assess the status of patients with the condition. More »
Physicians are being under-reimbursed for vaccinations nearly half the time, according to new data released by athenahealth. Most physicians are properly reimbursed for the cost of the vaccine itself, but getting paid for administration of the vaccine is another matter.
A 56-year old was seen in the ED after 4 days of hemoptysis and intermittent left chest pain. He also complained of exertional dyspnea and arthralgias. He had been treated for “pneumonia” twice during the past month. Histories were unremarkable.
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AbstractObjective To determine whether there is a relation between aortic diameter and morbidity and mortality in men screened for abdominal aortic aneurysm.Design Prospective cohort study.Setting Highland and Western Isles (a large, sparsely populated area of Scotland).Participants 8146 men aged 65-74.Main outcome measures Morbidity and mortality in relation to presence of abdominal aortic aneurysm and three categories of aortic diameter (24 mm, 25-29 mm, and 30 mm).Results When screened, 414 men (
Prolonged exposure to hyperoxia in neonates can cause hyperoxic acute lung injury (HALI), which is characterized by increased pulmonary permeability and diffuse infiltration of various inflammatory cells. Disruption of the epithelial barrier may lead to altered pulmonary permeability and maintenance of barrier properties requires intact epithelial tight junctions (TJs). However, in neonatal animals, relatively little is known about how the TJ proteins are expressed in the pulmonary epithelium, including w
An international peer-reviewed journal for health professionals in all aspects of respiratory medicine. ... Relative versus absolute change in forced vital capacity in idiopathic pulmonary fibrosis.
Over the past few years there have been an increasing number of research articles published in Thorax on respiratorytract infections (including tuberculosis) affecting children and adults. Although these articles cover a wide variety of areas, several broad themes can be discerned. These include greater interest in viral respiratory infections (partially stimulated by the recent influenza A pandemic), improved characterisation of who is at risk of community-acquired pneumonia and mycobacterial infection, research into better diagnostics and attempts to develop new or improved scoring scales for a range of respiratory infection syndromes. There have also been a limited number of articles on how to manage patients with respiratory infection, including describing the efficacy of prevention by vaccination. Overall, there has been a discernible emphasis on transferring advances in clinical science to actual clinical practice, with several papers using molecular methodologies or measuring
Community respiratory viruses are significant causes of morbidity and mortality in patients with leukemia and hematopoietic stem cell transplant (HSCT) recipients. Data on characteristics and outcomes of parainfluenza virus (PIV) infections in these patients are limited. We reviewed the records of patients with leukemia and HSCT recipients who developed PIV infections to determine the characteristics and outcomes of such infections. We identified 200 patients with PIV infections, including 80 (40%) patients with leukemia and 120 (60%) recipients of HSCT. At presentation, most patients (70%) had an upper respiratorytract infection and the remaining patients (30%) had pneumonia. Neutropenia, APACHE II score more than 15, and respiratory coinfections were independent predictors of progression to pneumonia on multivariate analysis. Overall mortality rate was 9% at 30 days after diagnosis and 17% among patients who had PIV pneumonia, with no significant difference between patients with
Cardiac and pulmonary pathophysiologies are closely interdependent, which makes the management of patients with congenital heart disease (CHD) all the more complex. Pulmonary complications of CHD can be structural due to compression causing airway malacia or atelectasis of the lung. Surgical repair of CHD can also result in structural trauma to the respiratory system, e.g., chylothorax, subglottic stenosis, or diaphragmatic paralysis. Disruption of the Starling forces in the pulmonary vascular system in certain types of CHD lead to alveolar-capillary membrane damage and pulmonary oedema. This in turn results in poorly compliant lungs with a restrictive lung function pattern that can deteriorate to cause hypoxemia. The circulation post single ventricle palliative surgery (the so called "Fontan circulation") poses a unique spectrum of pulmonary pathophysiology with restrictive lung function and a low pulmonary blood flow state that predisposes to thromboembolic complications and plastic
We retrospectively investigated incidence, morbidity, and mortality of neonatal respiratory failure (NRF) in China, with special emphasis on surfactant treated very immature infants.|NRF was defined as respiratory hypoxemia requiring mechanical ventilation and/or nasal continuous positive airway pressure for at least 24 hours.|There were 6864 cases of NRF, composing 19.7% of total admissions to 55 NICUs in 2008. Of these cases, 62.8% were preterm, and 16.4% of very low birth weight (VLBW, <1500 g). The primary diseases were respiratory distress syndrome (RDS, 43.9%), pneumonia/sepsis (21.7%), transient respiratory insufficiency (14.7%), transient tachypnea (8.1%), and meconium aspiration syndrome (7.0%). Surfactant was given to 26.8% of infants with NRF and 54.8% infants with RDS. The survival rate of surfactant-treated RDS was 79.9% compared to 71.8% in those not receiving surfactant (P < .001). This was also true in those of VLBW, 59.8% vs 52.2% (P = .035), respectively. The overall
Red blood cell (RBC) transfusion is associated with lung injury in susceptible hosts, although many cases do not meet criteria for transfusion-related acute lung injury. Patients with underlying pulmonary fibrosis can exhibit precipitous deteriorations in respiratory status of unknown etiology defined as acute exacerbations due to superimposed lung injury syndrome. It is unclear whether RBC transfusion is associated with acute exacerbation of underlying pulmonary fibrosis.|We describe a patient who underwent an uneventful elective left total hip replacement but developed anemia postoperatively. Twenty-four hours after transfusion of her fifth nonleukoreduced AS-5 RBC unit, she developed new bilateral airspace infiltrates associated with progressive hypoxemia. These RBC units were 35 to 38 days old. Despite supportive care and diuresis, the patient remained profoundly hypoxemic with infiltrates that progressed to fibrosis.|The patient had mild subclinical lower-lobe predominant
These include, but are not limited to, asthma, emphysema, chronic bronchitis, pneumonia irrnormal and immunocompromised hosts, pulmonary emboli, sleep-related breathing disorders, lung nodules and masses, tuberculosis, fungal infections, and
Another clue that a respiratorytract infection is due to a cold or flu is that these types of infections are very contagious, and can be spread from person-to-person. ... Anthrax is not contagious. Therefore, if family members and co-workers have
Physician Performance Goals Are Great, But Balance Is More Realistic Jennifer Frank, MD, May 15, 2012 Performance measurements for physicians are well-intentioned and get me to rethink how I practice. But in the end I won't make the goals, so I'll have to go with balance over perfection.
Designing the Perfect Business Card for Your Medical Practice C. Noel Henley, MD, May 11, 2012 Does your business card say anything substantive about the valuable work you do in your practice? Here’s how to re-design your next business card for maximum impact and engagement.
Registered Nurses an Ideal Fit for Primary Care Practices Audrey "Christie" McLaughlin, RN, May 10, 2012 Here are four good reasons to hire a registered nurse for your primary care practice …maybe even instead of a medical assistant.
The Five Biggest Medical Practice Marketing Mistakes James Doulgeris, May 10, 2012 There are best practices to marketing your practice, but often, success is more about knowing what not to do. Here are the five most common pitfalls …and how to avoid them.
Can You Practice Medicine and Manage Your Practice? Rosemarie Nelson, May 9, 2012 Whether you practice alone, or in a group, if you're trying to see patients in this pay-for-volume environment and also run the business of your practice, you may be missing out on important opportunities.
Patients with COPD are often reluctant to talk about the negative impact of the disease on their lives. But these... 
Physicians are being under-reimbursed for vaccinations nearly half the time, according to new data released by athenahealth. Most physicians are properly reimbursed for the cost of the vaccine itself, but getting paid for administration of the vaccine is another matter.
A 56-year old was seen in the ED after 4 days of hemoptysis and intermittent left chest pain. He also complained of exertional dyspnea and arthralgias. He had been treated for “pneumonia” twice during the past month. Histories were unremarkable. 