Chest
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Since pulmonary nontuberculous mycobacteria (PNTM) lung disease was last reviewed in CHEST in 2008, new information has emerged spanning multiple domains, including epidemiology, transmission and pathogenesis, clinical presentation, diagnosis, and treatment. The overall prevalence of PNTM is increasing, and in the United States, areas of highest prevalence are clustered in distinct geographic locations with common environmental and socioeconomic factors. Although the accepted paradigm for transmission continues to be inhalation from the environment, provocative reports suggest that person-to-person transmission may occur. ⋯ It is now evident that Mycobacterium abscessus, an increasingly prevalent cause of PNTM lung disease, can be classified into three separate subspecies with differing genetic susceptibility or resistance to macrolides. Recent publications also raise the possibility of improved control of PNTM through enhanced adherence to current treatment guidelines as well as new approaches to treatment and even prevention. These and other recent developments and insights that may inform our approach to PNTM lung disease are reviewed and discussed.
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Multicenter Study Observational Study
The use of a fully automated automatic adaptive servo ventilation algorithm in the acute and chronic treatment of central sleep apnea.
Central sleep apnea (CSA), in association with obstructive disordered breathing, occurs in patients using opioids long-term and those with congestive heart failure. In these patients, treatment with CPAP frequently fails. The current adaptive servoventilation (ASV) devices are promising for the treatment of complex sleep-disordered breathing. These devices use algorithms to automatically titrate expiratory and inspiratory pressures. We hypothesized that an ASV device operating automatically would significantly reduce the frequency of breathing events in patients with mixed sleep apnea during polysomnography and with 3 months of treatment. ⋯ The ASV device treated complex breathing disorders using automated algorithms. Compared with CPAP, patients reported improved sleep quality. Home use of ASV remained effective with acceptable adherence and improvements in daytime sleepiness.