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Individuals with chronic obstructive pulmonary disease (COPD) experience high symptom burden, severe illness, and frequent deterioration in quality of life. Women with COPD represent a unique population with potential unmet care needs yet remain underrepresented in palliative care (PC) literature. The purpose of this study was to investigate specific needs of women with COPD, learn how COPD symptoms impact women, and explore factors related to PC knowledge, access, and barriers. A total of 30 individuals were enrolled in this prospective, single-arm multimethod study, using an adapted Maslow's hierarchy of needs framework. Fifteen participated in semistructured interviews. Women with advanced COPD identified care needs and barriers including access to medications/oxygen and resources (pulmonary rehabilitation/support groups), information about disease/treatment, and effect of weather conditions on symptoms. Some participants were not under the direct care of a pulmonologist but recognized the importance of their services. None of the participants had been referred to or received PC. This study provides evidence that women have unmet care needs, high symptom burden, and disease uncertainty. Women with COPD should have the opportunity to have the supportive care that PC offers. Palliative care and hospice nurses have opportunities to address unmet care needs, increased symptom burden, and disease uncertainty. [ABSTRACT FROM AUTHOR]

BACKGROUND: Inhaler education for patients with asthma and patients with COPD is typically provided by non-pulmonologists. We studied inhaler education by pulmonologists to determine changes in clinical outcomes and inhaler use. METHODS: This was a retrospective study of 296 subjects diagnosed with asthma, COPD, or both that evaluated use of inhaler technique education and its impact on (1) inhaler/dosage change consisting of dosage change in the same class of inhaler and/or change in number of inhalers, (2) forced expiratory volume in one second/forced vital capacity (FEV1/FVC%), (3) disease symptom control, (4) out-patient visits, (5) urgent care visits (6) emergency department visits, and (7) hospital admissions. One group received inhaler technique education by a pulmonologist while the other group did not. RESULTS: The pulmonologist inhaler technique--educated group had significantly decreased relative risk for inhaler/dosage increase (relative risk 0.57 [95% CI 0.34-0.96], P = .03) and significantly increased odds for symptom control (odds ratio 2.15 [95% CI 1.24-3.74], P = .01) at 1-y follow-up as compared to the no education group. No differences occurred for FEV1/FVC%, out-patient visits, urgent care visits, emergency department visits, and hospital admissions. CONCLUSIONS: Pulmonologist education of inhaler technique for patients with asthma and patients with COPD was associated with decreased relative risk for inhaler/dosage increase and increased odds for symptom control. We recommend pulmonologists provide education of inhaler technique to patients with asthma and patients with COPD and not rely on non-pulmonologist education alone. Prospective research is needed to confirm the importance of proper inhaler techniques. [ABSTRACT FROM AUTHOR]

Traditionally, doctors in most specialties work in relative isolation, frequently caring for patients alone or with just a nurse. State-of-the-art care for voice disorders involves a multidisciplinary model that has evolved since the 1980s. Optimal care includes not only a laryngologist who specializes in voice, but also a skilled speech-language pathologist, singing voice specialist, nurse clinician and/or an extended care provider such as a nurse practitioner or physician assistant; and arts medicine specialists in numerous other disciplines including pulmonology, endocrinology, gastroenterology, psychology, psychiatry and many other fields. Voice problems in singers are diagnosed and resolved most efficiently in an integrated team setting. [ABSTRACT FROM AUTHOR]

The analysis covers the case of a driver suffering from epilepsy for many years, who during an epileptic seizure, in a state of profound disturbance of consciousness, caused a road accident. Such situations usually result in the perpetrator being considered insane in relation to the allegation. The task of expert psychiatrists and psychologists is then to assess the likelihood of the perpetrator of the prohibited act repeating it, and to indicate to the court the optimal therapeutic precautionary or penal measure. These legal solutions also apply to perpetrators who were considered insane due to disturbances of consciousness occurring in the course of various somatic diseases, and not permanent mental disorders. Currently, there are no grounds for appointing expert neurologists, diabetologists, cardiologists, pulmonologists, and other specialists who would assess the legitimacy of taking precautionary measures, which may raise judicial doubts. Moreover, applying in such cases only the measures indicated in Article 93a § 1 of the Penal Code does not find any psychiatric and psychological justification. Consideration should be given to extending the catalog of protective measures to include the therapy of various somatic diseases in order to minimize the risk of developing deep mental disorders in the future. The work proposes new opinion-making solutions, which, however, requires changes in legal regulations. [ABSTRACT FROM AUTHOR]

In recent years bronchoscopy equipment has been improved with smaller instruments and larger size working channels. This has ensured that bronchoscopy offers both therapeutic and interventional options. As the experience of paediatric interventional pulmonologists continues to grow, more interventions are being performed. There is a scarcity of published evidence in the field of interventional bronchoscopy in paediatrics. This is even more relevant for complicated pulmonary tuberculosis (PTB). Therapeutic interventional bronchoscopy procedures can be used in the management of complicated tuberculosis, including for endoscopic enucleations, closure of fistulas, dilatations of bronchial stenosis and severe haemoptysis. Endoscopic therapeutic procedures in children with complicated TB may prevent thoracotomy. If done carefully these interventional procedures have a low complication rate. [ABSTRACT FROM AUTHOR]

Objective: To describe the performance of a pulmonologist-led lung cancer screening program using low dose CT (LDCT) in a cohort of outpatients with stable respiratory diseases in the Brazilian public health care system. Methods: This was a retrospective analysis of the first two rounds of lung cancer screening of patients enrolled in the program. Inclusion criteria were being between 55 and 80 years of age, being a current or former smoker (smoking cessation ≤ 15 years), and having a smoking history ≥ 30 pack-years. LDCT results were interpreted in accordance with the Lung CT Screening Reporting and Data System, and those with a score of 3 or 4 were considered positive screening. Incidental pleuropulmonary findings were sought in all reports. Results: LDCTs were requested for 791 patients during the study period, and 712 patients (90%) met the screening criteria. The mean patient age was 63 years, and most participants were current smokers (56%) with emphysema (78.5%) and other pleuropulmonary findings on CT (64%). Screening was positive in 14.0% and 5.6% of the cases in the first and second screening rounds, respectively. Lung cancer was detected in 1.5% of the patients in both first and second rounds (positive predictive value: 11.0% and 26.6%, respectively). The rate of early-stage (TNM I or II) screen-detected non-small cell carcinoma was 64.3%. Of the patients with positive screening, 19% were lost to follow-up before investigation was complete. Conclusions: The results of this screening program suggest its adequate performance in a cohort of patients with significant respiratory morbidity. The loss to follow-up rate highlights the need for constant monitoring and interventions to ensure adherence. [ABSTRACT FROM AUTHOR]

Expedited reporting of unexpected serious adverse reactions that occur during clinical trials conducted under an IND is a critical component of the clinical trial process designed to protect patients by identifying potential safety issues with new agents. However, in recent years, the US FDA has presented extensive data about the problem of uninformative IND safety reporting. Despite published guidance documents aimed at clarifying requirements for submission of IND safety reports for individual events, there continues to be significant over-reporting of these events by many sponsors. This leads to excessive burden for the sponsors, the investigators who conduct clinical trials, and the FDA reviewers, who must evaluate each individual report submitted by the sponsor. This trend has the potential to endanger patients by obscuring true safety signals. To address this problem, LUNGevity Foundation empaneled a multi-sector working group of its Scientific and Clinical Research Roundtable (SCRT) charged with identifying ways to reduce unnecessary distribution of serious adverse events (SAEs) reports. This paper outlines the working group's activities, including a brief list of serious adverse events "anticipated" to occur within the lung cancer population that are either related to the underlying disease or condition being studied, concomitant or background therapy, or events associated with a demographic parameter such as age. These "anticipated" events, while required to be reported by investigators to sponsors, in general, should not then be individually reported by sponsors to FDA and to individual investigators in an IND safety report because these events require aggregate analysis across the development program to determine if they occur more frequently in treated versus untreated patients. This paper also includes discussion of how the use of background threshold values, generated from real-world data, could serve as one potential tool to guide sponsors in making causality assessments. If sponsors and other key stakeholders within the clinical research ecosystem embrace this type of approach and refrain from reporting "anticipated" events as single IND safety reports to the FDA staff and to each participating investigator, it could significantly reduce the amount of unnecessary reporting and serve as a model for other disease areas. [ABSTRACT FROM AUTHOR]

Background: There has been a striking increase in electronic cigarette (EC) use in the United States. The beliefs and practices toward ECs among physicians are unknown. Objective: The purpose of this study was to investigate EC practice patterns among allergists, pulmonologists, and primary care physicians. Methods: An anonymous survey was sent to physicians. The survey contained 32 questions and addressed issues related to demographics, cessation counseling behaviors, personal use, and knowledge and beliefs about ECs. Statistical analysis was performed by using analysis of variance, the Pearson x² test, Fisher exact test, and logistic regression. Results: A total of 291 physicians completed the survey (222 primary care physicians, 33 pulmonologists, and 36 allergists) for a response rate of 46%. The allergists asked about tobacco cigarette use as frequently as did the pulmonologists and more than the primary care physicians (p < 0.001), but they rarely asked about EC use. The pulmonologists scored highest on selfreported knowledge on ECs, although all the groups answered <40% of the questions correctly. The allergists did not feel as comfortable about providing EC cessation counseling as did the pulmonologists and primary care physicians (p < 0.001). All three groups were equally unlikely to recommend ECs as a cessation tool for tobacco cigarette users. Conclusion: Allergists lacked knowledge and confidence in providing education and cessation counseling for EC users. As the number of patients who use these products continues to increase, there is an urgent need for all physicians to be comfortable and knowledgeable with counseling about ECs. [ABSTRACT FROM AUTHOR]

Just over 100 years ago, John Scott Haldane published a seminal report about the therapeutic potential of supplemental oxygen to treat hypoxemia. In the 1980s, a pair of clinical trials confirmed the benefit of long-term oxygen therapy in improving survival in patients with COPD associated with severe resting hypoxemia. This review provides a summary of evidence supporting long-term and short-term oxygen therapy, as well as the various types of oxygen equipment commonly used in homes to deliver supplemental oxygen. Because the majority of orders for home oxygen occur at hospital discharge following acute illness, a typical conversation between a patient and their pul- monologist following a COPD exacerbation is presented. The SHERLOCK Consortium, a multi- stakeholder group established following the publication of the COPD National Action Plan in 2017 is also detailed. Interim results of the SHERLOCK Consortium, which suggest a chain of care involving 9 steps to ensure that patients are successfully initiated on home oxygen therapy during transitions from hospital to home, are presented. Recommendations to support evidence-based policies in this high-risk population are provided. [ABSTRACT FROM AUTHOR]

BACKGROUND: COPD guidelines advise on inhaled medication use, yet no advice is offered on when to use and which type of patient could benefit from a specific delivery device. We investigated pulmonologists' perception of their knowledge and practices with delivery devices for COPD management. METHODS: An online survey was designed by a steering committee of American Thoracic Society clinicians and scientists and conducted by a national market research firm between January 7 and 29, 2016. RESULTS: Two hundred and five respondents completed the survey. Nearly 80% of the respondents believed that they were very knowledgeable in COPD management and the use of medications; 68% believed that they were knowledgeable about preventing exacerbations. Ninety-eight percent of the respondents stated that they were at least somewhat knowledgeable about devices. Many respondents (70%) stated that small-volume nebulizers were more effective than dry powder inhalers and pressurized metered-dose inhalers in the management of COPD exacerbations, and 63% believed that these were more effective in severe COPD (modified Medical Research Council dyspnea scale grade 4). Only 54% of the respondents discussed device options with their patients. Physician screening for physical or cognitive impairments that could impact device choices was 53% and 16%, respectively. Seventy percent of the respondents discussed device use, whereas 9% discussed cleaning and storage during a patient's first visit. Few respondents were very knowledgeable in teaching patients how to use devices (43%) and, specifically, how to use (32%) or clean and/or maintain (20%) small-volume nebulizers. CONCLUSIONS: Most respondents were confident in their knowledge about treating COPD. Fewer respondents were confident about the use and maintenance of inhalation devices, and most respondents desired to learn more about inhalation devices. [ABSTRACT FROM AUTHOR]

Background and objective Lung cancer is the leading cause of cancer-related death in China. The results from a randomized controlled trial using annual low-dose computed tomography (LDCT) in specific high-risk groups demonstrated a 20% reduction in lung cancer mortality. The aim of tihs study is to establish the China National lung cancer screening guidelines for clinical practice. Methods The China lung cancer early detection and treatment expert group (CLCEDTEG) established the China National Lung Cancer Screening Guideline with multidisciplinary representation including 4 thoracic surgeons, 4 thoracic radiologists, 2 medical oncologists, 2 pulmonologists, 2 pathologist, and 2 epidemiologist. Members have engaged in interdisciplinary collaborations regarding lung cancer screening and clinical care of patients with at risk for lung cancer. The expert group reviewed the literature, including screening trials in the United States and Europe and China, and discussed local best clinical practices in the China. A consensus-based guidelines, China National Lung Cancer Screening Guideline (CNLCSG), was recommended by CLCEDTEG appointed by the National Health and Family Planning Commission, based on results of the National Lung Screening Trial, systematic review of evidence related to LDCT screening, and protocol of lung cancer screening program conducted in rural China. Results Annual lung cancer screening with LDCT is recommended for high risk individuals aged 50-74 years who have at least a 20 pack-year smoking history and who currently smoke or have quit within the past five years. Individualized decision making should be conducted before LDCT screening. LDCT screening also represents an opportunity to educate patients as to the health risks of smoking; thus, education should be integrated into the screening process in order to assist smoking cessation. Conclusion A lung cancer screening guideline is recommended for the high-risk population in China. Additional research, including LDCT combined with biomarkers, is needed to optimize the approach to low-dose CT screening in the future. [ABSTRACT FROM AUTHOR]

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