Current opinion in pulmonary medicine
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With the improving survival of cystic fibrosis (CF) patients, the clinical spectrum of this complex multisystem disease continues to evolve. Epidemiologic studies have provided important insight into the disease course, prognosis, and complications. This review summarizes recent advances in our understanding of predictors of survival and outcome and modifiers of disease in CF. This review is not meant to be comprehensive, but highlights selected studies, many of which have particular relevance to the growing number of older CF patients. ⋯ Epidemiologic research in cystic fibrosis continues to inform patient care and clinical research, and to generate new hypotheses regarding pathophysiology. Survival and outcomes continue to improve in this multisystem disease. With continued improving survival, epidemiologic studies will be critical to tracking changes in prognosis and outcome.
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High-resolution CT (HRCT) imaging of the chest can provide both structural and functional lung analysis useful to evaluate initial and progressive cystic fibrosis (CF) lung disease. Chest HRCT scoring systems have been used to evaluate the extent and severity of CF specific airway and lung parenchymal disease. The purpose of this review is to summarize recent developments in HRCT and volumetric chest CT imaging, CF chest CT scoring systems, and review how HRCT/volumetric CT can provide useful outcome measures for future CF clinical research. ⋯ Chest HRCT and volumetric CT imaging can detect regional CF lung changes before changes in global pulmonary function measurements. Chest HRCT scoring has been used in descriptive studies defining CF lung disease severity, in longitudinal studies to define progression of disease, and in clinical intervention studies to evaluate treatment effects. In the last 2 years, CF CT research has evolved from solely using chest HRCT scoring systems to utilization of composite CT/PFT scores, quantitative airway and air trapping measurements, and the utilization of volumetric CT imaging to evaluate three-dimensional data sets in patients with CF lung disease.
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Obstructive sleep apnea is a common disorder. Despite reports of its role as a risk factor for postoperative morbidity and mortality, only a few investigators have examined the optimal treatment of patients during this vulnerable period. Recognition of obstructive sleep apnea during conscious sedation or in the perioperative period is important to prevent the occurrence of adverse outcomes. This review discusses the influence of sedative, anesthetic, and analgesic agents and other factors during the perioperative period on patients with obstructive sleep apnea. The aim of this article is to emphasize the importance of recognizing and appropriately treating surgical patients with obstructive sleep apnea. ⋯ Obstructive sleep apnea places a significant proportion of surgical patients at increased risk of perioperative complications. Obstructive sleep apnea can be induced, unmasked, or exacerbated by the effects of sedative, analgesic, and anesthetic agents regardless of the site of surgery. The role of sleep apnea as a risk factor for development of postoperative complications needs greater emphasis. Increased awareness of the risk posed by an obstructed upper airway and appropriate management are important to optimize the perioperative care of patients with obstructive sleep apnea.
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This review addresses the growing interest in the study of sleep during critical illness. ⋯ A more complete understanding of the etiopathogenesis of sleep derangements during mechanical ventilation may identify new interventions to help improve sleep, and possibly favorably influence short-term and long-term outcomes.
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There has been much recent interest in the use of macrolide antibiotics as chronic suppressive therapy in patients with cystic fibrosis. Three recent randomized, placebo-controlled trials have been conducted. ⋯ Azithromycin has entered the therapeutic armamentarium for patients with cystic fibrosis who are chronically infected with Pseudomonas aeruginosa. Improved lung function, a reduction in pulmonary exacerbations and antibiotic use, and weight gain are potential benefits of this drug. Future studies should address the use of azithromycin in other cystic fibrosis patient populations, including those patients without chronic infection with P. aeruginosa, children younger than 6 years of age, and those infected with Burkholderia cepacia complex. The mechanism of action of macrolide antibiotics in cystic fibrosis remains unknown.