Current opinion in pulmonary medicine
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Pneumonia and sepsis are major causes of morbidity and mortality. Lung defense against pathogens involves innate and acquired immune responses. In this review, we focus on lung pathogens associated with sepsis and the innate immune response to them. In addition to discussing typical lung pathogens, the structural defenses, antimicrobial particles, complement, and cellular components of the immune response against these pathogens are also explored. ⋯ Clearly, understanding the immune response in the lung is critical to the development of future therapeutics for pneumonia and sepsis. This review concludes with novel discoveries in the lung immune response, which may lead to future avenues of treatment.
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Pulmonary disease caused by nontuberculous mycobacteria is occurring with greater frequency, and previously unrecognized manifestations of nontuberculous mycobacteria are being identified. Paralleling this increase, improvements in laboratory techniques now allow for more precise identification of nontuberculous mycobacteria and recognition of new species. Consequently, clinicians are more often confronted with diagnostic and therapeutic challenges relevant to the care of patients with nontuberculous mycobacterial lung disease. ⋯ The present article will review our current understanding of nontuberculous mycobacterial pulmonary disease with particular emphasis on pathogenesis, diagnosis, and therapeutic decision making. Areas of clinical controversy in which current data are inadequate to guide our decision making will be highlighted.
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Nosocomial infections are common and are associated with considerable morbidity and mortality. The continuing evolution of multidrug resistant pathogens and ineffective therapy for the infections they cause has stimulated interest in the potential of probiotic products to prevent nosocomial infections. Probiotics are viable microorganisms that colonize the host and exert antibacterial and immunomodulatory effects. This article will review the current evidence for probiotics in preventing nosocomial infections, particularly pneumonia in a diverse population of critically ill patients. ⋯ Probiotic products reduce pathogenic colonization of the host. Despite the theoretical plausibility, there is currently insufficient evidence that probiotic products reduce the incidence of nosocomial pneumonia. Large, multicenter, randomized clinical trials utilizing a rigorous, invasive diagnostic approach to nosocomial pneumonia need to be performed to prospectively evaluate the utility of probiotic products. In addition, bench research needs to be performed to select the most appropriate probiotic formulation for different clinical applications.
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Review
Smoking: relationship to chronic bronchitis, chronic obstructive pulmonary disease and mortality.
To describe the recent findings concerning the relationship between smoking, chronic bronchitis, chronic obstructive pulmonary disease and mortality. ⋯ Chronic bronchitis is a marker identifying high-risk individuals. With respect to chronic obstructive pulmonary disease and mortality, interventions to promote smoking cessation are important to reduce these risks.
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In patients with chronic obstructive pulmonary disease, nasal inflammation often coexists with lower respiratory disease. We review the current understanding of the relationship between upper and lower airway disease, particularly in chronic obstructive pulmonary disease, including therapeutic implications. ⋯ Patients with chronic obstructive pulmonary disease should be assessed for coexistent rhinosinusitis. Therapy directed toward treating the upper airway is likely to improve the global health status of these patients. Since tobacco smoke can exacerbate upper airway symptoms, it is important to evaluate patients with rhinosinusitis for concomitant lower airway disease.