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Interstitial Lung Disease Associated with Systemic Sclerosis. 与系统性硬化症有关的间质性肺病
IF 3.2 3区 医学
Seminars in respiratory and critical care medicine Pub Date : 2024-06-01 Epub Date: 2024-05-07 DOI: 10.1055/s-0044-1786698
Valentine Mismetti, Salim Si-Mohamed, Vincent Cottin
{"title":"Interstitial Lung Disease Associated with Systemic Sclerosis.","authors":"Valentine Mismetti, Salim Si-Mohamed, Vincent Cottin","doi":"10.1055/s-0044-1786698","DOIUrl":"10.1055/s-0044-1786698","url":null,"abstract":"<p><p>Systemic sclerosis (SSc) is a rare autoimmune disease characterized by a tripod combining vasculopathy, fibrosis, and immune-mediated inflammatory processes. The prevalence of interstitial lung disease (ILD) in SSc varies according to the methods used to detect it, ranging from 25 to 95%. The fibrotic and vascular pulmonary manifestations of SSc, particularly ILD, are the main causes of morbidity and mortality, contributing to 35% of deaths. Although early trials were conducted with cyclophosphamide, more recent randomized controlled trials have been performed to assess the efficacy and tolerability of several medications, mostly mycophenolate, rituximab, tocilizumab, and nintedanib. Although many uncertainties remain, expert consensus is emerging to optimize the therapeutic management and to provide clinicians with evidence-based clinical practice guidelines for patients with SSc-ILD. This article provides an overview, in the light of the latest advances, of the available evidence for the diagnosis and management of SSc-ILD.</p>","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140877212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pulmonary Hypertension in Systemic Sclerosis. 结缔组织病的肺部表现。
IF 3.2 3区 医学
Seminars in respiratory and critical care medicine Pub Date : 2024-06-01 Epub Date: 2024-03-26 DOI: 10.1055/s-0044-1782607
Sarah Cullivan, Eleanor Cronin, Sean Gaine
{"title":"Pulmonary Hypertension in Systemic Sclerosis.","authors":"Sarah Cullivan, Eleanor Cronin, Sean Gaine","doi":"10.1055/s-0044-1782607","DOIUrl":"10.1055/s-0044-1782607","url":null,"abstract":"<p><p>Systemic sclerosis is a multisystem connective tissue disease that is associated with substantial morbidity and mortality. Visceral organ involvement is common in patients with systemic sclerosis and occurs independently of skin manifestations. Pulmonary hypertension (PH) is an important and prevalent complication of systemic sclerosis. The clinical classification of PH cohorts conditions with similar pathophysiological mechanisms into one of five groups. While patients with systemic sclerosis can manifest with a spectrum of pulmonary vascular disease, notable clinical groups include group 1 pulmonary arterial hypertension (PAH) associated with connective tissues disease, PAH with features of capillary/venous involvement, group 2 PH associated with left heart disease, and group 3 PH associated with interstitial lung disease. Considerable efforts have been made to advance screening methods for PH in systemic sclerosis including the DETECT and ASIG (Australian Scleroderma Interest Group) composite algorithms. Current guidelines recommend annual assessment of the risk of PAH as early recognition may result in attenuated hemodynamic impairment and improved survival. The treatment of PAH associated with systemic sclerosis requires a multidisciplinary team including a PH specialist and a rheumatologist to optimize immunomodulatory and PAH-specific therapies. Several potential biomarkers have been identified and there are several promising PAH therapies on the horizon such as the novel fusion protein sotatercept. This chapter provides an overview of PH in systemic sclerosis, with a specific focus on group 1 PAH.</p>","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140294466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Diagnostic Approach to Interstitial Lung Diseases Associated with Connective Tissue Diseases 与结缔组织疾病相关的间质性肺病的诊断方法
IF 3.2 3区 医学
Seminars in respiratory and critical care medicine Pub Date : 2024-04-17 DOI: 10.1055/s-0044-1785674
Ana C. Zamora, Lewis J. Wesselius, Michael B. Gotway, Henry D. Tazelaar, Alejandro Diaz-Arumir, Vivek Nagaraja
{"title":"Diagnostic Approach to Interstitial Lung Diseases Associated with Connective Tissue Diseases","authors":"Ana C. Zamora, Lewis J. Wesselius, Michael B. Gotway, Henry D. Tazelaar, Alejandro Diaz-Arumir, Vivek Nagaraja","doi":"10.1055/s-0044-1785674","DOIUrl":"https://doi.org/10.1055/s-0044-1785674","url":null,"abstract":"<p>Interstitial lung disorders are a group of respiratory diseases characterized by interstitial compartment infiltration, varying degrees of infiltration, and fibrosis, with or without small airway involvement. Although some are idiopathic (e.g., idiopathic pulmonary fibrosis, idiopathic interstitial pneumonias, and sarcoidosis), the great majority have an underlying etiology, such as systemic autoimmune rheumatic disease (SARD, also called Connective Tissue Diseases or CTD), inhalational exposure to organic matter, medications, and rarely, genetic disorders. This review focuses on diagnostic approaches in interstitial lung diseases associated with SARDs. To make an accurate diagnosis, a multidisciplinary, personalized approach is required, with input from various specialties, including pulmonary, rheumatology, radiology, and pathology, to reach a consensus. In a minority of patients, a definitive diagnosis cannot be established. Their clinical presentations and prognosis can be variable even within subsets of SARDs.</p> ","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140614347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Oral–Lung Microbiome Axis in Connective Tissue Disease-Related Interstitial Lung Disease 结缔组织病相关间质性肺病中的口腔-肺微生物组轴
IF 3.2 3区 医学
Seminars in respiratory and critical care medicine Pub Date : 2024-04-16 DOI: 10.1055/s-0044-1785673
Kale S. Bongers, Angeline Massett, David N. O'Dwyer
{"title":"The Oral–Lung Microbiome Axis in Connective Tissue Disease-Related Interstitial Lung Disease","authors":"Kale S. Bongers, Angeline Massett, David N. O'Dwyer","doi":"10.1055/s-0044-1785673","DOIUrl":"https://doi.org/10.1055/s-0044-1785673","url":null,"abstract":"<p>Connective tissue disease-related interstitial lung disease (CTD-ILD) is a frequent and serious complication of CTD, leading to high morbidity and mortality. Unfortunately, its pathogenesis remains poorly understood; however, one intriguing contributing factor may be the microbiome of the mouth and lungs. The oral microbiome, which is a major source of the lung microbiome through recurrent microaspiration, is altered in ILD patients. Moreover, in recent years, several lines of evidence suggest that changes in the oral and lung microbiota modulate the pulmonary immune response and thus may play a role in the pathogenesis of ILDs, including CTD-ILD. Here, we review the existing data demonstrating oral and lung microbiota dysbiosis and possible contributions to the development of CTD-ILD in rheumatoid arthritis, Sjögren's syndrome, systemic sclerosis, and systemic lupus erythematosus. We identify several areas of opportunity for future investigations into the role of the oral and lung microbiota in CTD-ILD.</p> ","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140614358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pulmonary Manifestations of Sjögren's Disease 斯约格伦病的肺部表现
IF 3.2 3区 医学
Seminars in respiratory and critical care medicine Pub Date : 2024-04-15 DOI: 10.1055/s-0044-1785675
Louise Byrne, Cormac McCarthy, Aurelie Fabre, Nishant Gupta
{"title":"Pulmonary Manifestations of Sjögren's Disease","authors":"Louise Byrne, Cormac McCarthy, Aurelie Fabre, Nishant Gupta","doi":"10.1055/s-0044-1785675","DOIUrl":"https://doi.org/10.1055/s-0044-1785675","url":null,"abstract":"<p>Sjögren's disease (SjD) is a chronic, progressive autoimmune condition of exocrine and extraglandular tissues. It can present with isolated disease characterized by lymphocytic infiltration of salivary or lacrimal glands, but in approximately one-third of the patients, lymphocytic infiltration extends beyond exocrine glands to involve extraglandular organs such as the lungs. Pulmonary complications have been reported to occur between 9 and 27% of patients with SjD across studies. Respiratory manifestations occur on a spectrum of severity and include airways disease, interstitial lung disease, cystic lung disease, and lymphoma. Lung involvement can greatly affect patients' quality of life, has a major impact on the overall prognosis, and frequently leads to alteration in the treatment plans, highlighting the importance of maintaining a high index of clinical suspicion and taking appropriate steps to facilitate early recognition and intervention.</p> ","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140601288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Severe Community-Acquired Pneumonia: Noninvasive Mechanical Ventilation, Intubation, and HFNT 严重社区获得性肺炎：无创机械通气、插管和 HFNT
IF 3.2 3区 医学
Seminars in respiratory and critical care medicine Pub Date : 2024-04-11 DOI: 10.1055/s-0043-1778140
Miquel Ferrer, Gennaro De Pascale, Eloisa S. Tanzarella, Massimo Antonelli
{"title":"Severe Community-Acquired Pneumonia: Noninvasive Mechanical Ventilation, Intubation, and HFNT","authors":"Miquel Ferrer, Gennaro De Pascale, Eloisa S. Tanzarella, Massimo Antonelli","doi":"10.1055/s-0043-1778140","DOIUrl":"https://doi.org/10.1055/s-0043-1778140","url":null,"abstract":"<p>Severe acute respiratory failure (ARF) is a major issue in patients with severe community-acquired pneumonia (CAP). Standard oxygen therapy is the first-line therapy for ARF in the less severe cases. However, respiratory supports may be delivered in more severe clinical condition. In cases with life-threatening ARF, invasive mechanical ventilation (IMV) will be required. Noninvasive strategies such as high-flow nasal therapy (HFNT) or noninvasive ventilation (NIV) by either face mask or helmet might cover the gap between standard oxygen and IMV. The objective of all the supporting measures for ARF is to gain time for the antimicrobial treatment to cure the pneumonia. There is uncertainty regarding which patients with severe CAP are most likely to benefit from each noninvasive support strategy. HFNT may be the first-line approach in the majority of patients. While NIV may be relatively contraindicated in patients with excessive secretions, facial hair/structure resulting in air leaks or poor compliance, NIV may be preferable in those with increased work of breathing, respiratory muscle fatigue, and congestive heart failure, in which the positive pressure of NIV may positively impact hemodynamics. A trial of NIV might be considered for select patients with hypoxemic ARF if there are no contraindications, with close monitoring by an experienced clinical team who can intubate patients promptly if they deteriorate. In such cases, individual clinician judgement is key to choose NIV, interface, and settings. Due to the paucity of studies addressing IMV in this population, the protective mechanical ventilation strategies recommended by guidelines for acute respiratory distress syndrome can be reasonably applied in patients with severe CAP.</p> ","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140601790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Corrigendum: Severe Community-Acquired Pneumonia: Noninvasive Mechanical Ventilation, Intubation, and HFNT. 更正：严重社区获得性肺炎：无创机械通气、插管和 HFNT。
IF 3.2 3区 医学
Seminars in respiratory and critical care medicine Pub Date : 2024-04-01 Epub Date: 2024-05-20 DOI: 10.1055/s-0044-1786980
Miquel Ferrer, Gennaro De Pascale, Eloisa S Tanzarella, Massimo Antonelli
{"title":"Corrigendum: Severe Community-Acquired Pneumonia: Noninvasive Mechanical Ventilation, Intubation, and HFNT.","authors":"Miquel Ferrer, Gennaro De Pascale, Eloisa S Tanzarella, Massimo Antonelli","doi":"10.1055/s-0044-1786980","DOIUrl":"https://doi.org/10.1055/s-0044-1786980","url":null,"abstract":"","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141071568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Microbiology of Severe Community-Acquired Pneumonia and the Role of Rapid Molecular Techniques. 严重社区获得性肺炎的微生物学和快速分子技术的作用。
IF 3.2 3区 医学
Seminars in respiratory and critical care medicine Pub Date : 2024-04-01 Epub Date: 2024-01-09 DOI: 10.1055/s-0043-1777770
Chiagozie I Pickens, Catherine A Gao, Luisa Morales-Nebreda, Richard G Wunderink
{"title":"Microbiology of Severe Community-Acquired Pneumonia and the Role of Rapid Molecular Techniques.","authors":"Chiagozie I Pickens, Catherine A Gao, Luisa Morales-Nebreda, Richard G Wunderink","doi":"10.1055/s-0043-1777770","DOIUrl":"10.1055/s-0043-1777770","url":null,"abstract":"<p><p>The microbiology of severe community acquired pneumonia (SCAP) has implications on management, clinical outcomes and public health policy. Therefore, knowledge of the etiologies of SCAP and methods to identify these microorganisms is key. Bacteria including Streptococcus pneumoniae, Staphylococcus aureus and Enterobacteriaceae continue to be important causes of SCAP. Viruses remain the most commonly identified etiology of SCAP. Atypical organisms are also important etiologies of SCAP and are critical to identify for public health. With the increased number of immunocompromised individuals, less common pathogens may also be found as the causative agent of SCAP. Traditional diagnostic tests, including semi-quantitative respiratory cultures, blood cultures and urinary antigens continue to hold an important role in the evaluation of patients with SCAP. Many of the limitations of the aforementioned tests are addressed by rapid, molecular diagnostic tests. Molecular diagnostics utilize culture-independent technology to identify species-specific genetic sequences. These tests are often semi-automated and provide results within hours, which provides an opportunity for expedient antibiotic stewardship. The existing literature suggests molecular diagnostic techniques may improve antibiotic stewardship in CAP, and future research should investigate optimal methods for implementation of these assays into clinical practice.</p>","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139404279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Treatment Failure and Clinical Stability in Severe Community-Acquired Pneumonia. 严重社区获得性肺炎的治疗失败和临床稳定性。
IF 3.2 3区 医学
Seminars in respiratory and critical care medicine Pub Date : 2024-04-01 Epub Date: 2024-01-15 DOI: 10.1055/s-0043-1778139
Raúl Méndez, Paula González-Jiménez, Noé Mengot, Rosario Menéndez
{"title":"Treatment Failure and Clinical Stability in Severe Community-Acquired Pneumonia.","authors":"Raúl Méndez, Paula González-Jiménez, Noé Mengot, Rosario Menéndez","doi":"10.1055/s-0043-1778139","DOIUrl":"10.1055/s-0043-1778139","url":null,"abstract":"<p><p>Treatment failure and clinical stability are important outcomes in community-acquired pneumonia (CAP). It is essential to know the causes and risk factors for treatment failure and delay in reaching clinical stability in CAP. The study of both as well as the associated underlying mechanisms and host response are key to improving outcomes in pneumonia.</p>","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139472714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Aspiration Pneumonia. 吸入性肺炎
IF 3.2 3区 医学
Seminars in respiratory and critical care medicine Pub Date : 2024-04-01 Epub Date: 2024-01-11 DOI: 10.1055/s-0043-1777772
Di Pan, Samuel Chung, Erik Nielsen, Michael S Niederman
{"title":"Aspiration Pneumonia.","authors":"Di Pan, Samuel Chung, Erik Nielsen, Michael S Niederman","doi":"10.1055/s-0043-1777772","DOIUrl":"10.1055/s-0043-1777772","url":null,"abstract":"<p><p>Aspiration pneumonia is a lower respiratory tract infection that results from inhalation of foreign material, often gastric and oropharyngeal contents. It is important to distinguish this from a similar entity, aspiration with chemical pneumonitis, as treatment approaches may differ. An evolving understanding of the human microbiome has shed light on the pathogenesis of aspiration pneumonia, suggesting that dysbiosis, repetitive injury, and inflammatory responses play a role in its development. Risk factors for aspiration events involve a complex interplay of anatomical and physiological dysfunctions in the nervous, gastrointestinal, and pulmonary systems. Current treatment strategies have shifted away from anaerobic organisms as leading pathogens. Prevention of aspiration pneumonia primarily involves addressing oropharyngeal dysphagia, a significant risk factor for aspiration pneumonia, particularly among elderly individuals and those with cognitive and neurodegenerative disorders.</p>","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139425459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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