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Long-Term Effects of a 12-Week Exercise Training Program on Clinical Outcomes in Idiopathic Pulmonary Fibrosis

Conclusions At 11-month follow-up, the 12-week ET program showed clinical outcomes were preserved at baseline levels with some maintenance of improvements in leg strength and QOL in the ET group. The control group showed a trend of deterioration in the outcomes. At 30 months, the 12-week ET program did not show benefits in prognosis although the study was underpowered to detect such differences. We suggest including ET as a long-term continued treatment and as a core component of pulmonary rehabilitation programs for IPF patients. (Source: Lung)

New therapeutic options for noncystic fibrosis bronchiectasis

Purpose of review: Patients with noncystic fibrosis bronchiectasis (NCFB) share many of the respiratory symptoms of cystic fibrosis and often are provided therapies effective in cystic fibrosis, often without clear evidence of benefit. There are currently no approved therapies for NCFB, but in recent years, there has been increased interest in developing new therapies due to the increasing prevalence and perceived unmet needs. This review is meant to provide the most recent information to clinicians about currently available and pipeline therapies for NCFB.

Recent findings: Inhaled antibiotics may provide effective bacterial suppressive therapy with an acceptable safety profile in adults with NCFB, although evidence of improved outcomes is limited. Inhaled hyperosmolar agents such as hyper...

How to choose the duration of antibiotic therapy in patients with pneumonia

Purpose of review: The appropriate duration of antimicrobial treatment in patients with pneumonia remains a matter of controversy. The purpose of this article is to review different approaches that have been used to determine the duration of antimicrobial therapy mainly driven either by the antibiotic chosen, isolated pathogen, host characteristics, or severity of the disease. Recent findings: When considered individually, every approach has strengths and weaknesses. Targeting the duration of antibiotic therapy based on a single biomarker, such as procalcitonin, is a promising approach that showed a reduction in antibiotic exposure in different settings, diseases, and study populations. Furthermore, an individualized approach according to time to reach clinical stability takes into account...

Rapid diagnostic tests for defining the cause of community-acquired pneumonia

Purpose of review: We review the potential new diagnostic tools for determining the cause of pneumonia in the setting of community-acquired infection after outlining the limitation of currently available tests. Recent findings: A number of new tools are on the horizon with the potential to overcome the problems of existing tests. These tools include new nucleic acid amplification platforms, real-time computer-assisted microscopy, next-generation sequencing and high-throughput mass spectrometry. All of these tests still face significant barriers before they can enter general clinical practice including cost, reliability and physician acceptance. Summary: Although new platforms are exciting and do offer the promise of finally moving beyond our current very limited scope of microbiological te...

Antibiotic de-escalation in the ICU: how is it best done?

Purpose of review: An antimicrobial policy consisting of the initial use of wide-spectrum antimicrobials followed by a reassessment of treatment when culture results are available is termed de-escalation therapy. Our aim is to examine the safety and feasibility of antibiotic de-escalation in critically ill patients providing practical tips about how to accomplish this strategy in the critical care setting. Recent findings: Numerous studies have assessed the rates of de-escalation therapy (range from 10 to 60%) in patients with severe sepsis or ventilator-associated pneumonia as well as the factors associated with de-escalation. De-escalation generally refers to a reduction in the spectrum of administered antibiotics through the discontinuation of antibiotics or switching to an agent with a...

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