Current opinion in pulmonary medicine
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Pulmonary tuberculosis is a major cause of morbidity and mortality worldwide, resulting in the greatest number of deaths due to any one single infectious agent. This trend is due, at least in part, to increasing numbers of individuals co-infected with HIV and Mycobacterium tuberculosis (MTB). ⋯ Further, newer, longer-acting antituberculous therapeutic agents such as rifapentine, which allow twice-weekly dosing in the continuation phase of anti-MTB therapy, have recently been released and are undergoing clinical trials. This review provides a synopsis of recent developments in these areas and serves as a reference source for interested readers.
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Chronic obstructive pulmonary disease (COPD) continues to cause a heavy health and economic burden around the world. Recent studies have added evidence to the etiologic role of known and suspected risk factors for lung function decline and COPD, including smoking, occupational exposures, air pollution, airway hyperresponsiveness, and certain genetic variations. Among most populations, COPD prevalence and mortality are still increasing and will likely continue to rise in response to increases in smoking, particularly by women and adolescents. Resources aimed at smoking cessation and prevention and the early detection of COPD will be of the most benefit in our continuing efforts against this important cause of morbidity and mortality.
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Despite significant progress in therapy for cystic fibrosis (CF), most patients with the disease still die before the age of 30 years. Published discussions and descriptions of end-of-life care of patients with CF have been few, but interest in these issues is increasing. ⋯ Advanced care planning offers an opportunity for persons with CF to actively influence the type of care they will receive. Still, more empiric research and ethical discussion is needed to facilitate optimal end-of-life care of patients with CF.
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In various studies, it has been postulated that pharyngeal collapse occurring during sleep in obstructive sleep apnea may be alleviated by stimulating the genioglossus muscle. Basic experiments have demonstrated that neuromuscular stimulation applied intraorally via electrodes or by direct neural stimulation of the hypoglossal nerve might improve upper airway and respiratory function. ⋯ An impairment of sleep quality during electric stimulation has been excluded simultaneously. Considering clinical aspects, anatomical properties and long-term experience in electric stimulation it might be possible to develop full implantable devices as an alternative treatment for patients with obstructive sleep apnea.
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Idiopathic interstitial pneumonias are currently classified into four categories of disease: usual, desquamative, and acute interstitial pneumonia, and nonspecific interstitial pneumonia and fibrosis. Usual interstitial pneumonia appears on high-resolution CT (HRCT) as patchy subpleural areas of ground-glass opacity, irregular lines, and honeycombing. Desquamative interstitial pneumonia presents as patchy subpleural areas of ground-glass opacity in middle and lower lung zones. ⋯ Additional expiratory HRCT scans and scans with patients prone help to narrow the differential diagnosis among various diseases and help diagnose or exclude subtle disease in the posterior part of the lung, respectively. HRCT provides a reproducible method for evaluating the global extent of disease. It also discriminates between fibrotic and reversible inflammatory diseases.