Sleep disorders, including sleep apnea, have become a significant health issue in the United States. It is estimated that 22 million Americans suffer from sleep apnea, with 80 percent of the cases of moderate and severe obstructive sleep apnea going undiagnosed. This number continues to increase with the obesity epidemic. Sleep disordered breathing is associated with multiple cardiopulmonary diseases

Despite substantial progress in the long-term follow-up strategies for lung transplant recipients, morbidity and mortality remain high mostly due to the elevated infectious risk and to the development of chronic lung allograft dysfunction. The high immunosuppressive levels necessary to prevent acute rejection and the graft‘s constant exposure to the environment come at the high price of frequent infectious

Background Current guidelines recommend empiric antifungal therapy in sepsis patients with high risk of invasive Candida infection. However, many different risk factors have been derived from multiple studies. These risk factors lack specificity and broad application would render the majority of ICU patient eligible for empiric antifungal therapy. Research Question What risk factors for invasive Candida

Asthma is a common and heterogeneous disease, characterised by lower airway inflammation and airflow limitation. Critical factors in asthma management include establishing an accurate diagnosis and ensuring appropriate selection and dosage of anti-inflammatory therapies. The majority of asthma patients exhibit type 2 (T2) inflammation, with increased interleukin (IL)-4, IL-5, and IL-13 signalling,

Background International guidelines suggest using a higher (>10 cmH2O) positive end-expiratory pressure (PEEP) in patients with moderate-to-severe acute respiratory distress syndrome (ARDS) due to the novel coronavirus disease (COVID-19). However, even if oxygenation generally improves with a higher PEEP, compliance and arterial carbon dioxide tension (PaCO2) frequently do not, as if recruitment was

Background Population-based and retrospective studies have shown that risk for cardiovascular events such as arrythmias, ischemic episodes or heart failure, increase during and after bronchiectasis exacerbations. Research Question What are the risk factors for cardiovascular events (CVE) during and after bronchiectasis exacerbations and its impact on mortality? Study Design and Methods This was a post-hoc

Background Alpha-1 antitrypsin deficiency (AATD) is an autosomal co-dominant condition that predisposes to emphysema, cirrhosis, panniculitis, and vasculitis. Under-recognition has prompted efforts to enhance early detection and testing of at-risk individuals. Direct-to-consumer (DTC) genetic testing represents an additional method of detection. Research Question The study addressed three questions:

Pulmonary arterial hypertension (PAH) is a rare disease associated with abnormally elevated pulmonary pressures and right heart failure resulting in high morbidity and mortality. While PAH prognosis has improved with the introduction of pulmonary vasodilators, disease progression remains a major problem. Given that available therapies are inadequate for preventing small vessel loss and obstruction

Patients admitted to the intensive care unit with critical COVID-19 often require prolonged periods of mechanical ventilation. Difficulty weaning, lack of progress, and clinical deterioration are commonly encountered. These conditions should prompt a thorough evaluation for persistent or untreated manifestations of COVID-19, as well as complications from COVID-19 and its various treatments. Inflammation

Background Multiparametric risk assessment is used in pulmonary arterial hypertension (PAH) to target therapy. However, this strategy is imperfect as most patients remain in intermediate or high risk after initial treatment with low risk being the goal. Metrics of right ventricular (RV) adaptation are promising tools that may help refine our therapeutic strategy. Research Question Does RV adaptation

Background Direct oral anticoagulants (DOACs) are an alternative to low-molecular-weight heparin for treating cancer-associated venous thromboembolism (VTE). Research Question: Is rivaroxaban as efficient and safe as dalteparin to treat patients with cancer-associated VTE? Study Design and Methods : In a randomized open-label non-inferiority trial, patients with active cancer who had proximal deep-vein

Nontuberculous mycobacterial pulmonary disease (NTM-PD) continues to impose a significant clinical burden of disease on susceptible patients. The incidence of NTM-PD is rising globally but it remains a condition that is challenging to diagnose and treat effectively. This review provides an update on the global epidemiology, risk factors and diagnostic considerations associated with the management of

Asthma-COPD overlap (ACO) is a heterogeneous condition that describes patients who have persistent airflow limitation with clinical features that support both asthma and chronic obstructive pulmonary disease (COPD). Although there is no single consensus definition to diagnose this entity, common major criteria include a strong bronchodilator reversibility or bronchial hyperreactivity, a physician diagnosis

Excessive dynamic airway collapse (EDAC) contributes to breathlessness and reduced quality of life in individuals with emphysema. We tested a novel, portable, oral positive expiratory pressure (o-PEP) device in a patient with emphysema and EDAC. MRI revealed expiratory tracheal narrowing to 80 mm2 that increased to 170 mm2 with the o-PEP device. After 2-weeks use of the o-PEP device for 33% to 66% of

Case Presentation A 30-year-old transgender woman who was HIV positive presented to the ED with progressive severe dyspnea and hemoptysis that started 1 day earlier. The patient was undergoing antiretroviral therapy with emtricitabine-rilpivirine-tenofovir with good compliance and feminizing hormone therapy with cyproterone acetate. She was otherwise healthy and was not taking any other medications

Case Presentation A 30-year-old woman was referred with increasing shortness of breath and cough in the setting of GATA2 deficiency. She initially presented 9 years previously with recurrent episodes of pneumonia and sinusitis. Genetic testing revealed a heterozygous GATA2 mutation (c.988C>T). She has since had multiple infections that have included necrotizing fasciitis of the right thumb, recurrent

Case Presentation A 70-year-old man was referred for evaluation of recurrent respiratory infections requiring antibiotics and chronic cough over 3 years. Two months prior to presentation, he started to develop blood-tinged sputum but not frank hemoptysis. He otherwise denied any fever, chills, night sweats, or weight loss. He had dyspnea during the respiratory infections but not otherwise. His medical

Case Presentation A 58-year-old woman presented to a pulmonology clinic for evaluation of bilateral pulmonary nodules. Two years previously, she had presented with atrioventricular nodal reentrant tachycardia. During evaluation for her tachyarrhythmia, transthoracic echocardiogram (TTE) revealed a large, homogenous, highly mobile right atrial and ventricular mass. She underwent electrophysiologic ablation

Case Presentation A 51-year-old White male never-smoker presented with intermittent cough and progressive dyspnea. His symptoms started after an exposure to bat guano while cleaning his attic approximately 9 months earlier. He has received several courses of antibiotic and corticosteroid for these symptoms, with short-term relief.

Background Ventricular function, including left ventricular systolic dysfunction (LVSD), right ventricular systolic dysfunction (RVSD), and biventricular dysfunction (BVD), contribute to shock in cardiac intensive care unit (CICU) patients, but the prognostic utility remains unclear. Research Question Do patients with ventricular dysfunction have higher mortality at each Society for Cardiovascular

Background Pulse oximeters may be less accurate in non-White patients. Research Question Do pulse oximeter less effectively detect arterial hypoxemia in Black, Hispanic, and/or Asian patients than in White patients in respiratory failure about to initiate Extracorporeal Membrane Oxygenation (ECMO)? Study Design and Methods Extracorporeal Life Support Organization (ELSO) Registry of adult patients with

Background Emerging data from longitudinal studies suggest that PRISm, defined by proportionate reductions in FEV1 and FVC, is a heterogeneous population with frequent transitions to other lung function categories relative to individuals with normal and obstructive spirometry. Controversy regarding the clinical significance of these transitions exists (e.g., whether transitions merely reflect measurement

Background Pulmonary vascular microthrombi are a proposed mechanism of COVID19 respiratory failure. We hypothesized that early administration of tissue-plasminogen activator(tPA) followed by therapeutic heparin would improve pulmonary function in these patients. Research Question Does tPA improve pulmonary function in severe COVID-19 respiratory failure, and is it safe? Study Design and Methods Adults

Though long-neglected, the right heart (RH) is now widely accepted as a pivotal player in heart failure (HF) either with reduced (HFrEF) or preserved (HFpEF) ejection fraction. The chronic overload of the pulmonary microcirculation results in an initial phase characterized by right ventricular (RV) hypertrophy, right atrial (RA) dilation, and diastolic dysfunction. This progresses to overt right heart

Severe forms of pulmonary embolism (PE) in children are rare but cause significant morbidity and mortality. In this article, we review the pathophysiology of severe (high- and intermediate-risk) PE and suggest novel pediatric-specific risk stratifications and an acute treatment algorithm to expedite emergent decision making. We define pediatric high-risk PE as causing cardiopulmonary arrest, sustained

Pre-recorded video content in medical education has become more common. Increasingly accessible technology coupled with the COVID-19 pandemic and subsequent need for distanced learning has greatly increased the interest and need for high-quality video content. The use of short educational videos to augment other teaching methods has been shown to improve learners’ experiences, knowledge retention and

In December of 2019, the command of a United States Army Advanced Individual Training battalion on Fort Eustis in Virginia was briefed on the results of tobacco and nicotine use surveys distributed to trainee soldiers and subsequently decided to ban tobacco and nicotine products in this population. The policy implementation process was thoroughly planned in a joint effort between battalion leadership

Background The recent discovery that a combination of noradrenergic and antimuscarinic drugs improved upper airway muscle function during sleep and reduced obstructive sleep apnea (OSA) severity has revitalized interest in pharmacological therapies for OSA. Research Question Would 1-week of reboxetine plus oxybutynin be effective on OSA severity? Study Design and Methods We performed a randomized,

Asthma is a common chronic airway disease with significant impact on patients, caregivers, and the healthcare system. While most research and novel interventions have mainly focused on patients with uncontrolled severe asthma, the majority of patients with asthma have mild disease. Epidemiologic studies suggest that many patients with mild asthma report frequent exacerbations of their disease and uncontrolled

Cystic fibrosis is a progressive monogenetic disorder that causes persistent pulmonary disease, but also affects other organ systems including the digestive tract. Recent advances in treatment and care of CF patients including the use of new and highly effective CFTR modulators, have led to a dramatic increase in survival; young patients with CF can now expect to live to or beyond middle age, where

Background Expiratory muscle weakness and impaired airway clearance are early signs of respiratory dysfunction in Duchenne muscular dystrophy (DMD), a degenerative muscle disorder in which muscle cells are damaged and replaced by fibrofatty tissue. Little is known about expiratory muscle pathology and its relationship to cough and airway clearance capacity; however, the level of muscle replacement

Background In order to fully recognize the benefit of lung cancer screening annual adherence must approach the high levels seen in the National Lung Screening Trial. Emerging data suggests annual adherence is poor and that a centralized approach to screening improves adherence. Research Question Is there a difference in adherence between a centralized and decentralized approach to lung cancer screening