Lung cancer screening has come a long way since the early studies with chest X-ray. Advancing technology and progress in the processing of images have enabled low dose CT to be tried and tested, and evidence suggests its use can result in a significant mortality benefit. There are several issues that need refining in order to successfully implement screening in the UK and elsewhere. Some countries have started patchy implementation of screening and there is increased recognition that the appropriate management of pulmonary nodules is crucial to optimise benefits of early detection, while reducing harm caused by inappropriate medical intervention.

This review summarises and differentiates the many recent guidelines on pulmonary nodule management, discusses screening activity in other countries and exposes the present barriers to implementation in the UK.

Chronic respiratory insufficiency represents the advanced stage of a heterogeneous group of respiratory diseases, including COPD, which have an associated high cost burden.1 Modern information communication technologies offer new options to deliver remote specialised healthcare, among which telemonitoring, a complex intervention that includes both the electronic transmission of patient information to the healthcare system and the follow-up response by a healthcare professional. The rationale for telemonitoring development in patients presenting with chronic respiratory insufficiency with or without home mechanical ventilation need is related to: (1) progressive ageing of the patient population carrying with it an increased burden of care at home; (2) technological advances; (3) increased healthcare consumption and the need to cut costs; (4) the increasing number of home mechanical ventilation patients across Europe;2 (5) difficulties associated with hospital discharge, with tremendous physical and psychological burden for caregivers of home mechanical ventilation patients;

Lire la suite...

Rationale for a new guideline for the ventilatory management of acute hypercapnic respiratory failure in adults

The concept of augmenting spontaneous breathing effort by a close fitting face mask has evolved from initial case reports, nearly two decades ago, to become part of mainstream acute clinical care. Indeed, it has become the preferred option to invasive ventilation in many cases of acute hypercapnic respiratory failure (AHRF). In the UK, service development has been driven largely by respiratory physicians and this has resulted in an unintended, and unhelpful, dichotomy of responsibility for patient care. NIV guidelines that have been published have, by being concerned with the practicalities of delivery of a new service, failed to promote appropriate integration between those providing the acute NIV service and intensivists, the gate keepers to the intensive care unit (ICU) and who manage the invasively ventilated patient.

The joint British Thoracic Society (BTS)...

Related Articles

Disposition and Safety of Inhaled Biodegradable Nanomedicines: Opportunities and Challenges.

Nanomedicine. 2016 Mar 23;

Authors: Haque S, Whittaker MR, McIntosh MP, Pouton CW, Kaminskas LM

Abstract
The inhaled delivery of nanomedicines can provide a novel, non-invasive therapeutic strategy for the more localised treatment of lung-resident diseases and potentially also enable the systemic delivery of therapeutics that are otherwise administered via injection alone. However, the clinical translation of inhalable nanomedicine is being hampered by our lack of understanding about their disposition and clearance from the lungs. This review provides a comprehensive overview of the biodegradable nanomaterials that are currently being explored as inhalable drug delivery systems and our current understanding of their disposition within, and clearance from the lungs. The safety of biodegradable nanomaterials in the lungs is discussed and latest updates are provided on the impact of inflammation on the pulmonary pharmacokinetics of inhaled nanomaterials. Overall, the review provides an in-depth and critical assessment of the lung clearance mechanisms for inhaled biodegradable nanomedicines and highlights the opportunities and challenges for their translation into the clinic.

PMID: 27033834 [PubMed - as supplied by publisher]