Chest
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Aspergillus species cause diverse clinical manifestations in bronchiectasis including allergic bronchopulmonary aspergillosis (ABPA), Aspergillus sensitization (AS), and raised IgG indicating exposure to or infection with Aspergillus. ⋯ Aspergillus lung disease is common in bronchiectasis. Raised IgG levels to Aspergillus are associated with significantly worse outcomes, whereas ABPA and AS are associated with severe disease and exacerbations with a risk that is attenuated by ICS use.
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Recent treatment guidelines for COPD have replaced the long-acting beta2-agonist (LABA) and inhaled corticosteroid (ICS) combination with single-inhaler triple therapy that adds a long-acting muscarinic antagonist (LAMA) (LAMA-LABA-ICS). However, the corresponding trials reported numerically higher incidences of cardiovascular adverse events with triple therapy compared with LABA-ICS. ⋯ In a real-world setting of COPD treatment, patients who initiated single-inhaler triple therapy had an increased incidence of MACEs compared with similar patients treated with an LABA-ICS inhaler. This small increase was due to the all-cause mortality component, occurring mainly in the first 4 months after treatment initiation.
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The clinical and prognostic characteristics of mild-to-moderate COPD with and without emphysema remain inadequately investigated. ⋯ gov.
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Pulmonary endarterectomy (PEA) is the treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH). Although most have normalization of pulmonary artery (PA) pressures, development of residual pulmonary hypertension (RPH) is challenging to predict. ⋯ Patients with mixed thrombi were less likely to have RPH, suggesting there may be an optimum time to perform PEA after the clot has mostly organized, but prior to development of irreversible small vessel disease.
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Alongside the recognized Global Initiative for Obstructive Lung Disease (GOLD) classification, the Staging of Airflow Obstruction by Ratio (STAR) severity scheme has been proposed for categorizing COPD. ⋯ STAR exhibits a more uniform gradation of disease severity and enhanced performance in detecting hyperinflation, but our preliminary findings do not endorse its utilization in the rehabilitation setting.