Chest
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Advanced technologies such as endobronchial ultrasound and electromagnetic navigation have revolutionized the field of bronchoscopy. Its indications as a diagnostic as well as a therapeutic tool continue to expand at a rapid pace. This growth also has led to the emergence of a new subspecialty of interventional pulmonology and more than 40 fellowship training programs. ⋯ On the basis of a literature review and our own experience, we produced a list of conditions for which bronchoscopy is of limited value yet is being performed frequently. Conditions such as idiopathic pulmonary fibrosis, massive hemoptysis, cystic fibrosis, smear-negative pulmonary TB, and stage I sarcoidosis may be approached best in a more prudent fashion, with the bronchoscopic approach reserved for exceptional cases. We present an overview of conditions for which the expectations for bronchoscopy exceed the evidence in the literature, and we coined the term "forbearance with bronchoscopy" for situations in which this popular tool may not be the most appropriate initial approach.
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Editorial Biography Historical Article
Giants in Chest Medicine: Donald C. Zavala, MD, FCCP.
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Bronchiectasis is an important clinical syndrome because of its increasing prevalence, substantial economic burden on health care, and associated morbidity. Until recently, the disease was considered an orphan and essentially neglected from a therapeutic standpoint, but many recent advances have been made in the field. Several national registries have formed to provide databases from which to study patients with bronchiectasis. ⋯ In this regard, clinical tools have been developed to quantify disease severity and predict prognosis. Studies of different clinical phenotypes of bronchiectasis in patients with bronchiectasis have been published. With continued advances in the field of bronchiectasis, there is hope that evidenced-based therapies will become available.
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Editorial Comment
Weighing the Impact of CPAP Therapy on Body Mass in Persons With OSA.
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Randomized Controlled Trial Multicenter Study
The effects of long-term CPAP on weight change in patients with co-morbid OSA and cardiovascular disease: data from the SAVE trial.
Although recent evidence suggests that OSA treatment may cause weight gain, the long-term effects of CPAP on weight are not well established. ⋯ Long-term CPAP use in patients with comorbid OSA and cardiovascular disease does not result in clinically significant weight change.