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Diagnosis of pulmonary sarcoidosis

imagePurpose of reviewTo summarize and highlight recent advances in the field of the diagnosis of pulmonary sarcoidosis. Recent findingsSeveral techniques have emerged as important tools in the context of a clinical and radiological situation compatible with pulmonary sarcoidosis. Among them, computed tomography (CT) scan can not only exhibit characteristic imaging, but also contribute to an increased yield of tissue sampling through transbronchial biopsies. CT is also essential to the detection of mediastinal lymphadenopathy as potential targets of endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA). The latter is a well-tolerated and highly sensitive procedure which might become the first-line diagnostic tool in sarcoid patients with hilar or mediastinal lymph nodes. 18F deoxy-fluoro-glucose (18F-FDG) PET has a remarkable sensitivity in the detection of occult sites of the disease and a high value in guiding biopsy to these active sites. A combined imaging modality using both 18F-FDG PET and CT scan, more sensitive than PET alone, is now the standard of care in patients requiring histological sampling of active lesions. SummaryThe finding of noncaseating granulomas remains crucial to the diagnosis of sarcoidosis. The methods described here markedly enhance the diagnostic yield of tissue sampling along with low risks of complications.

Bronchoscopic Lung Volume Reduction

This article highlights the work currently ongoing in the area of bronchoscopic lung volume reduction. There are tools now clinically available in some locations throughout the world, but no standardized technique exists. (Source: Clinics in Chest Medicine)

Call for global COPD education shakeup

Researchers behind a global survey of chronic obstructive pulmonary disease patients say that more must be done to educate patients about the disease and what to do during exacerbations. (Source: MedWire News - Respiratory)

Spirometry use in children hospitalized with asthma

The objectives of this study were to describe the use of spirometry in children hospitalized with asthma and to determine association of pulmonary function with future exacerbations. A retrospective cohort study design was utilized involving review of medical records of children ≥5 years old admitted with asthma to Cincinnati Children's Hospital Medical Center from September 1, 2009 to March 31, 2011. Hospitalization or emergency department (ED) visits were identified by the ICD‐9‐CM codes of having either a primary diagnosis of asthma (493) or a respiratory illness (460–496) plus a secondary diagnosis of asthma. Asthma re‐exacerbation was defined as either having an ED visit or hospitalization for asthma that occurred within 3 months after the index hospitalization. All spiromet...

Optimization of anti‐pseudomonal antibiotics for cystic fibrosis pulmonary exacerbations: V. Aminoglycosides

Summary Intravenous (IV) anti‐pseudomonal aminoglycosides (i.e., amikacin and tobramycin) have been shown to be tolerable and effective in the treatment of acute pulmonary exacerbations (APEs) in both pediatric and adult patients with cystic fibrosis. The aim of this review is to provide an evidence‐based summary of pharmacokinetic/pharmacodynamic, tolerability, and efficacy studies utilizing IV amikacin, gentamicin, and tobramycin in the treatment of APE and to highlight areas where further investigation is needed. The Cystic Fibrosis Foundation Pulmonary Guidelines recommend that once‐daily administration of aminoglycosides is preferred over three times per day in the treatment of an APE. The literature supports dosing ranges for amikacin and tobramycin of 30–35 and 7–15 mg/k...

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