‘State of the Air 2019’ Finds Pollution Levels Rising in Many Areas

The American Lung Association’s 2019 “State of the Air” report finds that air quality in much of the nation got worse in 2015-2017. More cities had more days of high ozone and spikes in short-term particle pollution compared to last year’s report. Many cities also measured increased levels of year-round particle pollution. More people suffered from polluted air, too: the number of people living in counties that had unhealthy air increased to nearly 141.1 million from the previous report—that’s over 7 million more Americans exposed to unhealthy air than in last year’s report. Source…

Noninvasive Oxygenation Strategies For Acute Exacerbation of Interstitial Lung Disease: A Retrospective Single-center Study and a Review of the Literature

Acute exacerbation of interstitial lung disease (AE-ILD) causes severe respiratory failure so that the patients would often require mechanical ventilation. Mechanical ventilation may improve survival in selected patients with AE-ILD; however, in-hospital mortality rate is so high in patients who need mechanical ventilation that the use of mechanical ventilation is weakly recommended. Although there is no fixed strategy with regard to selection of oxygen devices, a palliative approach to how to spend the end-of-life periods is often needed. Although noninvasive ventilation may be used to avoid intubation, high-flow nasal cannula (HFNC) was developed in recent years and has been feasible and useful for acute respiratory failure of various causes. In terms of the quality of life, moreover, HFNC systems are associated with patient comfort and tolerance and more ability for oral intake of nutrition and less occurrence of cognitive dysfunction or coma. HFNC has broad utility, and it is likely that usage will increase more and more in the future. Limited data of its use in AE-ILD are available, and further study will be necessary. …

Subtle But Clinically Significant: A Review of Antibody Deficiencies in Adults

Primary immunodeficiency diseases are becoming more frequently diagnosed in the adult population. Although infections are the most common symptoms, patients can also present with sequelae of autoimmune and noninfectious pulmonary diseases, such as interstitial lung disease and granulomatous disease. Pulmonologists are likely to encounter patients with various and, at times, subtle symptoms suggestive of immunodeficiency. In this review article, we discuss the presentation, evaluation, and management of 4 antibody deficiencies: common variable immunodeficiency, selective immunoglobulin A deficiency, specific antibody deficiency, and immunoglobulin G subclass deficiency. …

Unilateral Multicystic Pulmonary Disease in a Young Adult: An Unusual Diagnosis

Congenital pulmonary airway malformation (CPAM) is an uncommon developmental hamartomatous anomaly caused by abnormal branching of immature bronchioles with replacement of the lung by cysts/disorganized tissue. CPAMs are usually lobar or sublobar in extent, and ∼90% of lesions are identified within the first 2 years of life. CPAM occupying an entire lung, with a delayed adulthood presentation, is extremely rare; only 4 such occurrences have been previously described. We present a case of a 20-year-old woman diagnosed with unilateral entire lung CPAM on the basis of radiologic findings that was surgically resected via video-assisted thoracoscopic surgery. …

The Clinical and Research Utility of Bronchoscopy in Cystic Fibrosis

Bronchoscopy is used in the management of cystic fibrosis (CF) for multiple reasons, of which sampling respiratory secretions has been the most frequent. The evidence behind the role of bronchoscopy for routine sampling of respiratory secretions to determine clinical management is lacking, although there remain well-accepted indications for bronchoscopy in research and follow-up of advanced therapies in the CF population. We review the clinical and research utility of bronchoscopy in patients with CF and outline promising research uses of this tool that can contribute to recent advances in understanding and treating CF. …

Palliative Care For Patients With Advanced Chronic Obstructive Pulmonary Disease (COPD) Remains Underutilized

Synopsis: COPD patients experience distressing symptoms and a poor quality of life. This population-based, repeated cross-sectional study suggests that palliative strategies in advanced disease remain underutilized. Source: Gershon AS, Maclagan LC, Luo J, et al. End-of-life strategies among patients with advanced chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2018;198:1389–1396. …

Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome: The Doctors are In, but the Jury is Still Out

Despite attempts to optimize outcomes in acute respiratory distress syndrome (ARDS) using mechanical ventilation and medical management, the mortality associated with this syndrome remains very high. The use of extracorporeal membrane oxygenation (ECMO), particularly veno-venous ECMO (VV-ECMO), as a rescue therapy has grown significantly in recent decades. This review outlines the risks and benefits of ECMO for the treatment of ARDS, examines the body of evidence behind this practice, including 4 randomized controlled trials and 2 case-controlled studies, and discusses the remaining questions and directions for future research. Because VV-ECMO is far more frequently used in the treatment of ARDS than veno-arterial ECMO, referral to ECMO in this review will imply VV-ECMO unless specifically stated. …