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There are limited US Federal Drug Administration-approved medications and real-world data on sarcoidosis treatment in the United States. Concordance of practice patterns with guideline recommendations have not been well characterized. ⋯ Within the first year of diagnosis, 43% of patients with sarcoidosis were started on treatment. Nonsteroidal immunosuppressives were used in 40% of treated patients. Although factors associated with treatment initiation aligned with guideline recommendations, practice patterns of treatment were variable, particularly in choice and sequence of nonsteroidal immunosuppressive therapy, underscoring the need for future trials and comparative effectiveness studies.
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Parasitic infections in the United States are mostly seen in immigrants and travelers. In many cases, pulmonary and intensive care physicians fail to consider parasitic disease, which can result in delayed diagnosis and adverse outcomes. Almost 2000 cases of imported malaria are diagnosed in the United States each year. ⋯ Endemic regions include not only East Asia but also Southeast Asia, west Africa, the Pacific coast of Latin America, and even North America. Other parasitic infections can involve the lungs. This article aims to provide awareness of the most clinically relevant parasitic infections seen in pulmonary and critical care medicine.
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Interstitial lung diseases (ILDs) represent a broad group of heterogeneous parenchymal lung diseases. Some ILDs progress, causing architectural distortion and pulmonary fibrosis, and thus are called fibrotic ILDs. Recent studies have shown a beneficial effect of antifibrotic therapy in fibrotic ILDs other than idiopathic pulmonary fibrosis (IPF) that manifest progressive pulmonary fibrosis (PPF). However, it remains challenging to predict which patients with fibrotic ILDs will demonstrate PPF. Precision medicine approaches could identify patients at risk for progression and guide treatment in patients with IPF or PPF. ⋯ Substantial progress has been observed in the context of precision medicine approaches in fibrotic ILDs in recent years. Nonetheless, infrastructure, financial, regulatory, and ethical challenges remain before precision medicine in clinical practice can be implemented. Overcoming such barriers and moving from a one-size-fits-all approach to patient-centered care could improve patient quality of life and survival substantially.
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Pneumothorax is a major complication after endoscopic lung volume reduction with valves, with a prevalence of up to 34%. Although some patients benefit from valve implantation despite pneumothorax, others are significantly impaired after lung collapse. ⋯ Patients could be informed more individually about their risk of pneumothorax, which varies with target lobe location, fissure integrity, and reimplantation. The poor outcome and high complication rate of severe pneumothorax calls for future research into the prediction of severe pneumothorax.