Respirology : official journal of the Asian Pacific Society of Respirology
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The field of interventional pulmonology has rapidly expanded to include the management and treatment of complex diseases of the chest. The management of central airway obstruction, pleural disease diagnosis, treatment and palliation, advanced bronchoscopic techniques to aid in the diagnosis of lung cancer and innovative therapies to treat asthma and COPD have all emerged over the past decade. ⋯ In order to appropriately treat and manage these often complex medical situations, the physician should have an expert knowledge of all available modalities, the expertise to safely perform the procedure and the ability to minimize the risk of and manage the associated complications that may arise. In this chapter we review and update some of the bronchoscopic and pleural interventions offered by interventional pulmonologists as well as the associated complications and management.
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Comparative Study
Clinical characteristics of combined pulmonary fibrosis and emphysema.
This study describes the clinical characteristics of patients with CPFE and compares these with patients with COPD. It should therefore be noteworthy that the prevalence of lung cancer might be high in CPFE patients. ⋯ CPFE patients had some different clinical characteristics in comparison with COPD patients and may also have a high prevalence of lung cancer.
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Clinical and other features, as well as prognostic factors for survival, were examined in patients with rapidly progressive interstitial pneumonia. The disease entity included different histological patterns with diverse outcomes, and distinctions were not possible from baseline data. Histological diagnosis was the only significant prognostic determinant. ⋯ RPIP included varied histological patterns with different outcomes, and in many cases these could not be predicted using baseline clinical data. Histology was the only significant predictor of ultimate prognosis.
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Randomized Controlled Trial Multicenter Study
Sleep hypoventilation due to increased nocturnal oxygen flow in hypercapnic COPD patients.
This study shows the risks and benefits of increasing the nocturnal oxygen flow in hypercapnic COPD patients undergoing LTOT, as recommended by some COPD treatment guidelines to avoid nocturnal desaturation. ⋯ The increase of oxygen flow in severe COPD patients with established daytime hypercapnia improved nocturnal oxygenation but it also led to greater hypercapnia and respiratory acidosis at awakening in a considerable proportion of these patients.
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Comparative Study
Non-invasive positive pressure ventilation during sleep at 3800 m: Relationship to acute mountain sickness and sleeping oxyhaemoglobin saturation.
Overnight oxyhaemoglobin desaturation is related to AMS. AMS can be debilitating and may require descent. Positive pressure ventilation during sleep at high altitude may prevent AMS and therefore be useful in people travelling to high altitude, who are known to suffer from AMS. ⋯ The use of positive pressure ventilation during sleep at 3800 m significantly increased the sleeping oxygen saturation; we suggest that the marked reduction in symptoms of AMS is due to this higher sleeping SaO2. We agree with the findings from previous studies that the development of AMS is associated with a lower sleeping oxygen saturation.