Clinics in chest medicine
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Endobronchial ablative therapies are used to address a variety of malignant and benign airway lesions. By utilizing endobronchial ablative techniques patients with symptomatic airway lesions may receive significant symptom improvement, improved quality of life, and improved life expectancy. ⋯ The choice to use one therapy versus another depends on technical and patient specific factors. This article reviews indications and contraindications for each therapy, discusses details related to each endobronchial ablative therapy, complications of endobronchial ablative therapies, and briefly discusses practical consideration with endobronchial ablative therapies.
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Complex airway diseases represent a therapeutic challenge and require multidisciplinary input. Surgery remains the definitive modality. ⋯ However, it has limited use if lesions are located in the upper lobes or lung periphery, but significant technological advances allow for effective treatments using the flexible bronchoscope. Rigid and flexible bronchoscopes should be seen as complementary procedures and most cases require the use of both modalities.
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Clinics in chest medicine · Jun 2013
ReviewPneumocystis pneumonia associated with human immunodeficiency virus.
Pneumocystis pneumonia (PCP) is caused by the yeastlike fungus Pneumocystis. Despite the widespread availability of specific anti-Pneumocystis prophylaxis and of combination antiretroviral therapy (ART), PCP remains a common AIDS-defining presentation. PCP is increasingly recognized among persons living in Africa. ⋯ Trimethoprim-sulfamethoxazole remains the preferred first-line treatment regimen. In the era of ART, mortality from PCP is approximately 10% to 12%. The optimal time to start ART in a patient with PCP remains uncertain.
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Clinics in chest medicine · Jun 2013
ReviewFuture directions: lung aging, inflammation, and human immunodeficiency virus.
Chronic lung diseases, including chronic obstructive pulmonary disease (COPD) and pulmonary hypertension (PH), are unusually prevalent among persons infected with human immunodeficiency virus (HIV). Often these disease states are identified at younger ages than would be expected in the general population. Recent epidemiologic, basic scientific, and cross-sectional clinical data have implicated immune dysfunction and cellular senescence as potential drivers of advanced presentations of age-related diseases in HIV-infected persons. This article describes how HIV-associated COPD and PH may fit into a paradigm of immunosenescence, and outlines the hypothesized associations among chronic HIV infection, immune dysfunction and senescence, and cardiopulmonary outcomes.
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Clinics in chest medicine · Jun 2013
ReviewImpact of antiretroviral therapy on lung immunology and inflammation.
Human immunodeficiency virus (HIV) infection causes profound changes in the lung compartment characterized by macrophage and lymphocyte activation, secretion of proinflammatory cytokines and chemokines, and accumulation of CD8 T cells in the alveolar space, leading to lymphocytic alveolitis. Because many of the changes seen in the lung can be attributed to the direct effect of HIV on immune cells, therapy to reduce the HIV burden should have significant beneficial effects. Indeed, antiretroviral therapy rapidly reduces the viral burden in the lung, number of CD8 T cells in the alveolar space, and amount of proinflammatory cytokines and chemokines in bronchoalveolar lavage.