About 858 results
FDA broadens nintedanib interstitial lung disease indication
Mitchel L. Zoler

Mar 11th, 2020 - A new indication for the tyrosine kinase inhibitor nintedanib approved by the Food and Drug Administration on March 9, 2020, broadened the drug’s targeted population to include patients with chronic fibrosing interstitial lung diseases with a progressive phenotype. This new group of patients eligible for nintedanib treatment extends the drug’s labeling beyond patients with idiopathic pulmonary.

Disaster response. Medicare billing. Lung transplantation. Asthma.

Mar 10th, 2020 - Transplant Investigating clinical practice of lung transplantation in systemic sclerosis Interstitial lung disease (ILD) as a sequela of systemic sclerosis (SSc) poses a significant health concern. Patients with SSc-ILD experience symptoms of shortness of breath, reduced exercise capacity, and limited activities of daily living.

Roche Pushes to Kick-Start Lung Therapy Esbriet After Big Writedown

Mar 4th, 2020 - ZURICH, March 3 (Reuters) - Roche has won U.S. breakthrough therapy status for Esbriet for unclassifiable interstitial lung disease (uILD), the company said on Tuesday, as it aims to lift disappointing revenue by expanding conditions for which it can be used. Esbriet, approved in 2011 in Europe and 2014 in the United States, is now used to treat adults with lung-scarring idiopathic pulmonary fi...

Idiopathic pulmonary fibrosis in an era of personalized medicine
Lisa Hack

Feb 18th, 2020 - Useful not only as a clinical overview but also for patient information, these up-to-date statistics elucidate the symptoms and prevalence of pulmonary fibrosis; and recommendations for personalized treatment. To see the data in action, start reading here.

High-Res CT Has Key Role Detecting Lung Disease in Systemic Sclerosis

Feb 3rd, 2020 - NEW YORK (Reuters Health) - The first evidence-based consensus statements for systemic sclerosis-associated interstitial lung disease (SSc-ILD) recommend use of high-resolution computed tomography (CT) for screening and diagnosis, and offer guidance on when to initiate or escalate emerging treatment options. "We believe that the evidence-based expert consensus statements provide important clini...

Fast Five Quiz: Idiopathic Pulmonary Fibrosis Differential Diagnosis

Nov 19th, 2019 - Idiopathic pulmonary fibrosis (IPF) and usual interstitial pneumonitis (UIP) are the most common forms of chronic, progressive fibrosing interstitial pneumonia of unknown origin. The clinical course of IPF is complicated and the prognosis is poor, with a median survival of 3-5 years from diagnosis. Although early diagnosis and treatment can relieve symptoms and slow disease progression, there i...

Roche buys U.S. drugmaker Promedior for up to $1.4 billion to get lung drug

Nov 15th, 2019 - FILE PHOTO: The logo of Swiss drugmaker Roche is seen at its headquarters in Basel, Switzerland February 1, 2018. REUTERS/Arnd Wiegmann/File Photo ZURICH (Reuters) - Swiss drugmaker Roche is paying up to $1.4 billion to buy U.S. biotech company Promedior, whose main drug candidate against the lung disease idiopathic pulmonary fibrosis is set to begin late-stage trials, Promedior said on Friday....

Boehringer Ingelheim develops first and only therapy for systemic sclerosis-associated ILD

Nov 12th, 2019 - Interstitial lung disease (ILD), one of the most frequent manifestations of systemic sclerosis (SSc), or scleroderma, can be debilitating and may become life-threatening. Approximately 25 percent of SSc patients develop significant lung involvement within three years of diagnosis.

A 56-Year-Old Woman With Worsening Dyspnea and Sarcoidosis

Oct 30th, 2019 - Editor's Note: The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please ...

Mortality From Antineutrophil Cytoplasmic Autoantibody-Associated Vasculitis Falling Slightly

Oct 10th, 2019 - NEW YORK (Reuters Health) - Mortality rates in patients with antineutrophil cytoplasmic autoantibody-associated vasculitis (AAV) decreased from 1999 to 2017, according to records from the Centers for Disease Control and Prevention (CDC). "The mortality attributed to several rare diseases (e.g., hypersensitivity pneumonitis) has increased in recent years," Dr. Alexander W. Steinberg from Saint J...

The emerging role of quantitative CT scans in ILD terms
Samantha D’annunzio, MD, Christine Nayar, MD et. al.

Oct 9th, 2019 - The role of imaging for interstitial lung disease (ILD) is of paramount importance. With the growth of high resolution chest computed tomography (HRCT) imaging techniques, we are able to visualize nuances between individual ILDs more critically.

Scars and color changes on face
MDedge Family Medicine;

Oct 3rd, 2019 - The FP recognized the scarring, skin atrophy, erythema and hyperpigmentation in the malar distribution as discoid lupus erythematosus (DLE). Upon examination, the FP noted similar patterns (with the addition of hypopigmentation) in the conchal bowls of both pinna.

TKI preserved lung function in patients with fibrosing interstitial disease
Ted Bosworth

Sep 30th, 2019 - MADRID – In patients with fibrosing lung diseases other than idiopathic pulmonary fibrosis (IPF), nintedanib, a tyrosine kinase inhibitor, substantially reduced the rate of decline in lung function, according to findings from a phase 3, placebo-controlled trial presented at the annual congress of the European Respiratory Society. Ted Bosworth/MDedge News Dr.

Morning Break: Trebek Needs More Chemo; Smallpox Lab Explosion; 'Poop Shame'

Sep 18th, 2019 - Note that some links may require subscriptions. "Jeopardy!" host Alex Trebek told "Good Morning America" that he's had a setback in his fight against pancreatic cancer. Biogen's promising drug for idiopathic pulmonary fibrosis, BG00011, proved in a phase II trial to be too toxic to develop further. (Endpoints News) Merck's V920 Ebola vaccine took another step toward full availability, with the ...

Flesh-Colored Papules on the Scrotum
Shatha Ahmad Al Hajjaj, MD, Thomas M. Rünger, MD, PhD et. al.

Sep 17th, 2019 - The Diagnosis: Cutaneous Sarcoidosis Histologic examination of the shave biopsy showed focal parakeratosis, irregular epidermal hyperplasia, and multiple noncaseating naked granulomas with occasional multinucleated giant cells in the dermis (Figure, A). The granulomas were surrounded by mild lymphocytic infiltration with rare eosinophils (Figure, B).

FDA: Novel Breast Ca Drugs Linked to Severe Lung Illness

Sep 14th, 2019 - WASHINGTON -- The FDA issued a warning Friday that CDK4/6 inhibitors for advanced breast cancer may cause rare but severe lung inflammation, and said fatalities had been reported. Package warnings have been added to the three approved agents in the class -- palbociclib (Ibrance), ribociclib (Kisqali), and abemaciclib (Verzenio) -- and breast cancer patients taking these agents should be monitor...

Cutaneous Sarcoidosis Presenting as a Cutaneous Horn
Richard J. Browning, MD, Laura A. Greyling, MD et. al.

Sep 9th, 2019 - To the Editor: A 53-year-old woman presented to our dermatology clinic with a painful growth on the right ear of 2 months’ duration. A complete review of systems was negative except for an isolated episode of shortness of breath prior to presentation that resolved without intervention.

FDA OKs Nintedanib (Ofev) for Rare Lung Disease

Sep 8th, 2019 - The US Food and Drug Administration (FDA) has approved nintedanib (Ofev, Boehringer Ingelheim) capsules for slowing the rate of decline in pulmonary function in adults with systemic sclerosis–associated interstitial lung disease (SSc-ILD). Nintedanib is the first FDA-approved treatment for this rare lung condition. The FDA's Arthritis Advisory Committee recommended approving nintedanib for SSc-...

FDA approves nintedanib for scleroderma interstitial lung disease
Christopher Palmer, MDedge News

Sep 7th, 2019 - The Food and Drug Administration has approved nintedanib (Ofev) for the rare but sometimes deadly form of interstitial lung disease that’s caused by systemic sclerosis, or scleroderma. Olivier Le Moal/Getty Images Although scleroderma itself is rare, half of those patients present with scleroderma-related interstitial lung disease (SSc-ILD), and it remains the leading cause of death in sclerode.

FDA approves Boehringer's lung disease drug

Sep 6th, 2019 - (Reuters) - The U.S. Food and Drug Administration on Friday approved German drugmaker Boehringer Ingelheim’s Ofev capsules for a rare lung disorder. The drug is first FDA-approved treatment for this condition, the FDA said in a statement. The drug is aimed at slowing the rate of decline in pulmonary function in adults with interstitial lung disease associated with systemic sclerosis, an autoimm...

New Indication OK'd for Lung Drug Ofev

Sep 6th, 2019 - WASHINGTON -- Nintedanib (Ofev) may be marketed as a treatment for systemic sclerosis-associated interstitial lung disease (SSc-ILD), the FDA said Friday. Previously approved to treat idiopathic pulmonary fibrosis, nintedanib becomes the first treatment specifically indicated for SSc-ILD, for which few options are available. "Patients suffering from scleroderma [another name for systemic sclero...

In vasculitis, the skin tells the story
Kari Oakes

Aug 27th, 2019 - MILAN – Skin manifestations of the vasculitides can point the way to an accurate diagnosis and provide clues about disease severity, Robert Micheletti, MD, said at the World Congress of Dermatology. Dr.

Making a 'Working Diagnosis' of Idiopathic Pulmonary Fibrosis

Aug 14th, 2019 - Classification of interstitial lung disease (ILD) is challenging.[1] The most common and best studied ILD is idiopathic pulmonary fibrosis (IPF). Still, it makes up only one third of all ILD cases, and diagnosis is far from easy. Clinicians must integrate demographic, clinical, and CT features and decide whether surgical lung biopsy (SLB) would be helpful.[2] With expensive but effective therap...

This month in the journal CHEST ®
Peter J. Mazzone, MD, MPH, FCCP

Aug 9th, 2019 - COMMENTARY Imaging of Pulmonary Hypertension: Pictorial Essay By Dr. E.

Multiple hyperpigmented papules and plaques
MDedge Family Medicine;

Aug 1st, 2019 - Narrowing down a broad differential diagnosis Our cas a ase was made somewhat challenging by the patient’s darkly pigmented skin color, which made any erythema and other cutaneous signs less visible. The differential was broad and included postinflammatory hyperpigmentation from eczema, multiple congenital nevi, sarcoidosis, leprosy, and cutaneous tuberculosis, all of which can be eliminated by.

FDA Panel Narrowly Backs Ofev Label Expansion

Jul 26th, 2019 - SILVER SPRING, Md. -- An FDA advisory committee voted 10-7 Thursday that nintedanib (Ofev) should be approved to treat systemic sclerosis-associated interstitial lung disease (SSc-ILD). Currently marketed to treat idiopathic pulmonary fibrosis (IPF), nintedanib would become the first drug approved for SSc-ILD, a condition with few other options for treatment. SSc-ILD is the leading cause of dea...

FDA advisors recommend nintedanib for SSc interstitial lung disease
Mitchel L. Zoler

Jul 26th, 2019 - The Food and Drug Administration Arthritis Advisory Committee recommended approval of nintedanib for the treatment of interstitial lung disease in patients with systemic sclerosis by a 10-7 vote on July 25, 2019. If the FDA acts in accord with the panel’s recommendation, it would make nintedanib (Ofev) the first drug to receive marketing approval for this indication.

FDA Panel Recommends Nintedanib for Rare Lung Disease

Jul 25th, 2019 - The US Food and Drug Administration's (FDA's) Arthritis Advisory Committee has recommended approval of nintedanib (Ofev, Boehringer Ingelheim) for the treatment of systemic sclerosis-associated interstitial lung disease (SSc-ILD). The committee voted 10 to 7 that the data did provide substantial evidence of nintedanib's efficacy for SSc-ILD, and 14 to 2 (with 1 abstention) that the safety profi...

Rash over homemade tattoo
MDedge Family Medicine;

Jul 11th, 2019 - Although the FP had never seen anything like this before, he was aware that dyes in tattoos could cause an allergic reaction. His research also suggested that sarcoidosis could occur in a tattoo, so this was part of his differential diagnosis written on the pathology form.

Biologics. NetWork name change. Rapid sequence intubation. Competitive bidding. Genomic classifier.

Jul 11th, 2019 - Interstitial and diffuse lung disease New genomic classifier A confident diagnosis of idiopathic pulmonary fibrosis (IPF) relies on the radiographic pattern of usual interstitial pneumonitis (UIP), although in some cases, histologic confirmation is warranted. Transbronchial biopsy (TBBx) does not provide adequate tissue for diagnosis, thus patients are subjected to the risk of a surgical biopsy.

Lesions on face, arms, and legs

Jul 4th, 2019 - The FP suspected that the patient had sarcoidosis, based on the infiltrated plaques and their distribution on her face. The appearance of the lesions was similar to images he’d seen online of lupus pernio, a pathognomonic finding of sarcoidosis.

Tocilizumab preserves lung function in systemic sclerosis
Sara Freeman, MDedge News

Jun 26th, 2019 - MADRID – Tocilizumab (Actemra) preserved lung function in patients with early systemic sclerosis (SSc), according to a secondary endpoint analysis of the phase 3, double-blind, randomized, controlled focuSSced trial. After 48 weeks, a significantly lower proportion of patients treated with tocilizumab than placebo experienced any decline in lung function from baseline (50.

Elevated monocyte count predicts poor outcomes in idiopathic pulmonary fibrosis

Jun 23rd, 2019 - Among patients in the COMET, Stanford, and Northwestern datasets, monocyte counts of 0. 95 K/mcL or greater were associated with mortality after adjustment for forced vital capacity (HR, 2.

Experts agree on routine lung disease screening in systemic sclerosis
Ted Bosworth

Jun 19th, 2019 - MADRID – The first consensus recommendations for the identification and management of interstitial lung disease (ILD) in patients with systemic sclerosis (SSc) place particular emphasis on routine screening in all systemic sclerosis patients for early detection, monitoring, and, when warranted, treatment, Anna-Maria Hoffmann-Vold, MD, PhD, reported at the European Congress of Rheumatology. Dr.

Is Sooner Better? The Push to Use Antifibrotics Early in IPF

Jun 16th, 2019 - Nintedanib and pirfenidone reduce the rate of functional vital capacity (FVC) decline in patients with idiopathic pulmonary fibrosis (IPF),[1] with several large, randomized controlled trials (RCTs) showing efficacy for this outcome.[2,3,4] Because IPF is a progressive disease that was considered untreatable before these drugs were approved by the US Food and Drug Administration, the news of th...

Fast Five Quiz: Idiopathic Pulmonary Fibrosis Treatment

Jun 16th, 2019 - Idiopathic pulmonary fibrosis (IPF) and usual interstitial pneumonitis (UIP) are the most common forms of chronic, progressive fibrosing interstitial pneumonia of unknown origin. Although the cause of IPF is unknown, factors thought to increase an individual's risk of developing IPF include a history of smoking, gastroesophageal reflux disease, environmental exposures, and genetic predispositio...

Fast Five Quiz: Diagnosing Idiopathic Pulmonary Fibrosis

Jun 16th, 2019 - Idiopathic pulmonary fibrosis (IPF) is the most common form of chronic, progressive fibrosing interstitial pneumonia of unknown origin. The histopathology and radiological findings of IPF are the same as those of usual interstitial pneumonia (UIP), and similar to many other cardiopulmonary conditions, the presenting signs and symptoms of IPF are usually nonspecific and include both respiratory ...

Lung Disease in RA: Which Factors are Linked With Mortality?

May 21st, 2019 - Among patients with rheumatoid arthritis (RA) who had interstitial lung disease (ILD), the pattern of ILD did influence mortality, but other pulmonary factors also contributed, a meta-analysis suggested. In 10 studies that compared the usual interstitial pneumonia (UIP) pattern of ILD with other patterns, an increased mortality risk was seen in the UIP group (RR 1.66, 95% CI 1.07-2.76) but hete...

Methotrexate does not cause rheumatoid interstitial lung disease
Sara Freeman

May 17th, 2019 - BIRMINGHAM, ENGLAND – Data from two early RA inception cohorts provide reassurance that methotrexate does not cause interstitial lung disease and suggest that treatment with methotrexate might even be protective. Sara Freeman/MDedge News Dr.

Coalescing Papules on Bilateral Mastectomy Scars
Brittany Blaise, MD, Ted Ryser, MD et. al.

May 7th, 2019 - The Diagnosis: Scar Sarcoidosis Although scars on both breasts were involved, the decision was made to biopsy the right breast because the patient reported more pain on the left breast. Biopsy showed noncaseating granulomas consistent with scar sarcoidosis (Figure).

Lung-Cancer Survival Worse in Patients With Pulmonary Fibrosis

Apr 25th, 2019 - NEW YORK (Reuters Health) - Non-small cell lung cancer (NSCLC) presents differently in patients with idiopathic pulmonary fibrosis (IPF), who also have higher overall and lung-cancer mortality, according to a new study. "We found that patients with IPF and lung cancer have a greater proportion of early stage disease of squamous histology in a lower lobe distribution," Dr. Stacey-Ann Whittaker B...

Diagnostic test helps clinicians identify IPF with nonsurgical biopsy
Jeff Craven

Apr 17th, 2019 - Researchers used a machine learning algorithm to identify a molecular signature for usual interstitial pneumonia in patients with suspected idiopathic pulmonary fibrosis, according to recent research published in the Lancet Respiratory Medicine. Dr.

IPAF: Heterogeneity Hurts Clinical Utility

Apr 14th, 2019 - Despite an official research statement[1] on interstitial pneumonia with autoimmune features (IPAF) in 2015, attempts to bring order to the disorganized world of interstitial lung disease (ILD) continue. Pulmonologists often encounter patients with ILD and collagen vascular disease (CVD) who don't meet the rheumatologic criteria for CVD. But, because guidelines and reviews[2,3] recommend that p...

Rash with hair loss
MDedge Family Medicine;

Apr 11th, 2019 - The FP had never seen a condition like this before, so he used some online resources to come up with a differential diagnosis that included sarcoidosis, leprosy, drug eruption, and mycosis fungoides. Aside from an occasional drug eruption, the other conditions were ones that he had seen in textbooks only.

Molecular Classifier Helps Spot Idiopathic Pulmonary Fibrosis

Apr 10th, 2019 - NEW YORK (Reuters Health) - A molecular classifier based on RNA-sequencing data from transbronchial lung biopsies can recognize an expression signature associated with usual interstitial pneumonia (UIP), the defining pathology of idiopathic pulmonary fibrosis (IPF). "Diagnosis of interstitial lung disease is frequently characterised by delay, misdiagnosis, use of costly and invasive procedures,...

CT honeycombing key to hypersensitivity pneumonitis prognosis
Andrew D. Bowser

Apr 9th, 2019 - In patients with hypersensitivity pneumonitis, presence of radiologic honeycombing suggests a poor prognosis in line with what might be expected with idiopathic pulmonary fibrosis, results of a recent study suggest. When radiologic honeycombing was present, event-free survival was uniformly poor, regardless of whether the patient had hypersensitivity pneumonitis (HP) or idiopathic pulmonary fib.

CT scan honeycombing key to hypersensitivity pneumonitis prognosis
Andrew D. Bowser

Apr 9th, 2019 - In patients with hypersensitivity pneumonitis, presence of radiologic honeycombing suggests a poor prognosis in line with what might be expected with idiopathic pulmonary fibrosis, results of a recent study suggest. When radiologic honeycombing was present, event-free survival was uniformly poor, regardless of whether the patient had hypersensitivity pneumonitis (HP) or idiopathic pulmonary fib.

Monocytes May Predict IPF Prognosis

Apr 2nd, 2019 - Increased monocyte count was associated with poorer outcomes in patients with idiopathic pulmonary fibrosis (IPF), according to a retrospective, multicenter analysis. Discovery analysis was performed using data from the Gene Expression Omnibus of the National Center for Biotechnology Information using 120 PBMC samples from patients with IPF, explained Purvesh Khatri, PhD, of Stanford University...

New IPF diagnosis test now covered by Medicare
Lucas Franki

Mar 6th, 2019 - The Envisia Genomic Classifier, produced by Veracyte, has received final Medicare local coverage determination for the diagnosis of idiopathic pulmonary fibrosis (IPF). Purestock/thinkstockphotos Envisia is a complement to high-resolution CT that can help differentiate IPF from other interstitial lung diseases, as more than half of patients with IPF/interstitial lung disease report being misdia.

Annular Atrophic Plaques on the Forearm
Christopher Tomassian, MD, Anand Rajpara, MD et. al.

Mar 6th, 2019 - Sarcoidosis is a systemic noncaseating granuloma­tous disease of unknown etiology. The skin is the second most common location for disease mani­festation following the lungs.

Palliative Care in Idiopathic Pulmonary Fibrosis

Feb 3rd, 2019 - 'Please, No More Doctors' Blake is a 70-year-old farmer diagnosed with idiopathic pulmonary fibrosis (IPF), a progressive fibrosing type of interstitial lung disease. Blake delayed seeking medical care but recently experienced worsened shortness of breath that was affecting his ability to function, so he visited his primary care doctor in a rural clinic near his home. His doctor referred Blake ...

Multicentric Reticulohistiocytosis With Arthralgia and Red-Orange Papulonodules

Jan 31st, 2019 - Cutaneous findings of MRH can mimic rheumatoid nodules, gout, Gottron papules of dermatomyositis, lipoid proteinosis, sarcoidosis, lepromatous leprosy, granuloma annulare, xanthoma, xanthogranuloma, and fibroxanthoma. 6,7 Histopathologic features may distinguish MRH from such entities.

INPULSIS-ON: Nintedanib shows manageable long-term safety for IPF
CHEST Physician; Amy Karon

Jan 15th, 2019 - For patients with idiopathic pulmonary fibrosis, up to 68 months of treatment with nintedanib showed acceptable safety and tolerability and might have slowed disease progression, according to the results of the open-label INPULSIS-ON trial. Purestock/thinkstockphotos No new safety signals were identified among patients who continued nintedanib or switched from placebo to the medication after co.

This month in the journal CHEST®Editor’s Picks
Richard S. Irwin, MD, FCCP, MDedge News

Jan 14th, 2019 - Giants in Chest Medicine Emeritus Professor Peter D. Wagner, MD By Dr.

New Section Editor for Pulmonary Perspectives®

Jan 14th, 2019 - We are pleased to announce Corey Kershaw, MD, as the new Section Editor for Pulmonary Perspectives. Dr.

Idiopathic Pulmonary Fibrosis: 5 Things to Know

Jan 10th, 2019 - Idiopathic pulmonary fibrosis (IPF) is a progressive, fibrotic lung disease most common in older men with exposure to tobacco smoke.[1] Two antifibrotic therapies, nintedanib and pirfenidone, were shown to reduce the rate of functional vital capacity (FVC) decline in patients with IPF.[2] Since the US Food and Drug Administration approved both drugs for patients with IPF in 2014, we have learne...

Glucocorticoid Treatment of Symptomatic Sarcoidosis in 2 Morbidly Obese Patients

Jan 10th, 2019 - Case 2: Cardiac Sarcoidosis A 57-year-old morbidly obese man presented to the emergency department with subacute increasing dyspnea on exertion. He had a known history of sarcoidosis diagnosed by skin biopsy 28 years earlier but had been without treatment for decades.

Pirfenidone Improves Idiopathic Pulmonary Fibrosis Survival

Jan 8th, 2019 - Treating patients who have idiopathic pulmonary fibrosis (IPF) with pirfenidone (Esbriet, Genentech) increases their 3-year survival rates and confers a 30% survival benefit compared with patients who have not been treated with antifibrotic agents, according to a retrospective observational intention-to-treat study. "The effect of pirfenidone on survival is remarkable if [one] takes into accoun...

Severe Cutaneous Sarcoid Responds to Tofacitinib

Jan 5th, 2019 - Researchers from Yale University in New Haven, Connecticut, demonstrated benefits to treating severe cutaneous sarcoidosis using tofacitinib (Xeljanz). Their report in the New England Journal of Medicine described a female patient, age 48, who was previously unresponsive to multiple medications, and had not received systemic glucocorticoids. She was treated with tofacitinib 10 mg twice-daily an...

Tofacitinib tackles cutaneous sarcoidosis
Heidi Splete

Dec 26th, 2018 - Tofacitinib significantly improved skin lesions associated with cutaneous sarcoidosis, according to a case report published in the New England Journal of Medicine. Treatment options for cutaneous sarcoidosis are limited, as are data on the effectiveness of alternatives to prednisone, which is often the first choice despite adverse effects, wrote William Damsky, MD, of Yale University in New Hav.

T marneffei Infection: Risk Extends to Patients Without HIV
Jan Dyer

Dec 6th, 2018 - Patients with HIV/AIDs are vulnerable to Talaromyces marneffei ( T marneffei ) infection , formerly penicilliosis. But in recent years more cases have been seen in patients not infected with HIV, too.

Midlife Lung Disease Linked to Later Dementia

Nov 29th, 2018 - Lung disease or impaired lung function in midlife is tied to an increased risk for subsequent dementia or mild cognitive impairment (MCI), results of a large, longitudinal study show. Overall, individuals with restrictive lung disease had a 58% higher risk for dementia or MCI compared to their counterparts without the condition. Those with obstructive lung disease had a 33% higher risk. "These ...

Rates, costs, mortality of RA-related interstitial lung disease analyzed in new study
Steve Cimino

Nov 27th, 2018 - Interstitial lung disease (ILD) is becoming more prevalent in patients with RA while shortening survival and leading to substantial health care costs, according to a retrospective study of RA-ILD prevalence, incidence, costs, and mortality. “To our knowledge, this is the first study to describe the incidence and prevalence of RA-ILD among the general population and to estimate costs among U.

Ichthyosiform Sarcoidosis and Systemic Involvement

Nov 26th, 2018 - Comment Etiology Although there are several theories regarding the etiology of sarcoidosis, the exact cause remains unknown. The body’s immune response, infectious agents, genetics, and the environment have all been thought to play a role.

Genetic risk factor found for RA-associated interstitial lung disease
Bruce Jancin

Oct 23rd, 2018 - CHICAGO – Rheumatoid arthritis–associated interstitial lung disease and idiopathic pulmonary fibrosis without RA share a common genetic underpinning whose hallmark is a gain-of-function MUC5B gene promoter variant that cranks up mucin production in the lungs, Pierre-Antoine Juge, MD, reported at the annual meeting of the American College of Rheumatology. Bruce Jancin/MDedge News Dr.

Precision medicine poised to improve IPF management
Andrew D. Bowser

Oct 9th, 2018 - SAN ANTONIO – Although the research is in early phases, precision medicine is on the cusp of developments that will improve the care of patients with idiopathic pulmonary fibrosis (IPF), Justin Oldham, MD, said in a plenary presentation at the annual meeting of the American College of Chest Physicians. “IPF is a highly variable disease,” said Dr.

Idiopathic Pulmonary Fibrosis Clinical Practice Guidelines (2018)

Sep 30th, 2018 - The clinical practice guidelines on the diagnosis of idiopathic pulmonary fibrosis were released on September 1, 2018, by the American Thoracic Society, European Respiratory Society, Japanese Respiratory Society, and Latin American Thoracic Society.[1,2] Obtain a detailed history for possible environmental exposures or medication use to exclude potential causes of interstitial lung disease (ILD...

Sildenafil added to nintedanib offers no benefit in IPF patients
Ted Bosworth

Sep 19th, 2018 - PARIS – Despite the promise of sildenafil for idiopathic pulmonary fibrosis (IPF), adding this therapy to nintedanib in IPF patients who have significantly impaired gas exchange did not improve quality of life (QOL), according to a randomized trial presented at the annual congress of the European Respiratory Society and simultaneously published in the New England Journal of Medicine (2018 Sep 1.

Updated IPF guideline refines diagnostic criteria with HRCT
Will Pass

Sep 17th, 2018 - A recently updated guideline for idiopathic pulmonary fibrosis (IPF) provides refined diagnostic criteria in an effort to improve clinical application and diagnostic accuracy. ©Sergey Nivens/thinkstockphotos Of note, the guideline recommends that high-resolution CT (HRCT) patterns be used to dictate management course.

New Guideline Updates Diagnostic Criteria for IPF

Sep 11th, 2018 - An updated clinical practice guideline for diagnosing interstitial pulmonary fibrosis (IPF) defines four diagnostic categories on the basis of lung imaging and provides specific testing pathways for each of them. Clinicians should first obtain a detailed history of medication use and environmental exposures to exclude potential causes of interstitial lung disease (ILD) and conduct serologic tes...

Flexible Bronchoscopic Removal of 3 Foreign Objects

Sep 10th, 2018 - Discussion More than 50% of foreign bodies lodge at the right main stem bronchus due to the trachea’s anatomical position. 2,4 In adults, foreign-body aspiration may present with nonspecific symptoms, such as cough and dyspnea.

Anti-Reflux Surgery Slows Idiopathic Lung Fibrosis

Aug 17th, 2018 - Action Points Laparoscopic anti-reflux surgery in patients with idiopathic pulmonary fibrosis (IPF) and abnormal acid gastroesophageal reflux disorder (GERD) is safe and well tolerated, but the therapeutic value of the procedure in IPF-GERD subgroup should be confirmed in larger, more generalizable trials. Note there is a longstanding hypothesis that abnormal acid reflux may contribute to progr...

ILD in Scleroderma: Response Markers Remain Elusive

Jul 11th, 2018 - The use of cyclophosphamide for patients with interstitial lung disease (ILD) associated with systemic sclerosis (SSc) stabilized pulmonary function over 3 years, but the extent of inflammation early in the disease process did not significantly influence the effects of the treatment, a retrospective study found. At month 12 after cyclophosphamide treatment was started, forced vital capacity (FV...

Vitamin D Deficiency Linked to Lung Fibrosis

Jun 21st, 2018 - Vitamin D deficiency was independently associated with subclinical interstitial lung disease (ILD) and its progression in adults in a community setting participating in the Multi-Ethnic Study of Atherosclerosis (MESA). The researchers said the observational findings, published in the Journal of Nutrition, "lend support to the potential role of adequate vitamin D concentrations for the preventio...

Idiopathic pulmonary fibrosis a ‘robust diagnosis’
Rheumatology News; Sara Freeman

Jun 6th, 2018 - LIVERPOOL, ENGLAND – Very few patients with idiopathic pulmonary fibrosis have connective tissue disease antibodies, suggesting that IPF is a “robust diagnosis” when made on the basis of standard diagnostic tests, it was reported at the British Society for Rheumatology annual conference. “The results were perhaps not what we’d expected,” said Caroline V.

Sarcoidosis Resulting in Exsanguinating Esophageal Variceal Hemorrhage
Adam Blumenberg, MD, MA, Sophia Sharifali, MD et. al.

Jun 4th, 2018 - Sarcoidosis is a systemic disorder of unknown etiology and is characterized by the formation of granulomas throughout various organs in the body. The most common form is pulmonary sarcoidosis, which affects 90% of patients; the second most common form is oculocutaneous sarcoidosis;1 and the third most common form is hepatic sarcoidosis, which affects 63% to 90% of patients.

VIDEO: Let clinical scenario, not imaging, guide sarcoidosis treatment
Michele G. Sullivan, MDedge News

May 18th, 2018 - SANDESTIN, FLA. – Don’t be a slave to imaging when evaluating the patient with sarcoidosis.

New ILD diagnostic test is available
Katie Wagner Lennon, MDedge News

May 18th, 2018 - A 190-gene test for interstitial lung diseases (ILD), including idiopathic pulmonary fibrosis (IPF), is now available for use through an early-access program. IPF can be difficult to distinguish from other ILDs, S.

It takes a village to care for the patient with idiopathic pulmonary fibrosis
Aryeh Fischer, MD

May 1st, 2018 - Idiopathic pulmonary fibrosis (IPF) is a devastating progressive fibrosing interstitial lung disease associated with a high burden of morbidity and death. 1 A clinical diagnosis of IPF is made only after careful interpretation of integrated clinical, radiologic, and often histopathologic data.

Idiopathic pulmonary fibrosis: What primary care physicians need to know
Leslie B. Tolle, MD, Brian D. Southern, MD et. al.

May 1st, 2018 - Idiopathic pulmonary fibrosis (IPF) is a devastating and fatal lung disease that generally affects older adults. It is characterized by a radiographic and histopathologic pattern of usual interstitial pneumonia (UIP) that has no other known etiology.

Migraine Common in Patients with Sarcoidosis
Gelfand JM, Gelfand AA et. al.

Apr 25th, 2018 - Migraine is a common comorbidity in patients with sarcoidosis, according to a recent study. As such, better recognition and targeted treatment of migraine has the potential to improve quality of life as part of a comprehensive care plan for those with sarcoidosis.

A Cluster of Idiopathic Pulmonary Fibrosis Cases
Jan Dyer

Apr 16th, 2018 - In 2016, a Virginia dentist who had been recently diagnosed with idiopathic pulmonary fibrosis (IPF) was being treated at a specialty clinic. The CDC was contacted to report concerns that IPF had been diagnosed in multiple dentists, also from Virginia, who had also sought treatment at the same specialty clinic.

Pharmacologic Treatments for Idiopathic Pulmonary Fibrosis
Kelly Dunn, MMSc, PA-C

Apr 13th, 2018 - IN THIS ARTICLE Confirming the diagnosis Pirfenidone treatment Nintedanib treatment A 64-year-old man has a one-year history of dyspnea on exertion and a nonproductive cough. His symptoms are gradually worsening and increasingly bothersome to him.

CDC Finds Cluster of Pulmonary Disease in Dentists

Mar 7th, 2018 - The first cluster of idiopathic pulmonary fibrosis (IPF) was identified among nine dental personnel seen at a tertiary care center between 2000 and 2015, a number 23 times higher than expected, the Centers for Disease Control and Prevention (CDC) reports. IPF has been linked to other occupations; however, these are the first published data to show a link with dentistry, the authors explain. Den...

Postherpetic Isotopic Responses With 3 Simultaneously Occurring Reactions Following Herpes Zoster
Ashley Miles Jenkins, MD, Daniel Skinner, MD et. al.

Mar 6th, 2018 - Postherpetic isotopic response (PHIR) refers to the occurrence of a second disease manifesting at the site of prior herpes infection. Many forms of PHIR have been described (Table), with postzoster granulomatous dermatitis (eg, granuloma annulare, sarcoidosis, granulomatous vasculitis) being the most common.

No Consensus Treatment for Neurosarcoidosis

Feb 28th, 2018 - NAPLES, FL—Although patients with symptomatic neurosarcoidosis account for approximately 5% to 15% of people with systemic sarcoidosis, making it a rare manifestation of an uncommon disorder, neurosarcoidosis is associated with substantial morbidity and with mortality rates ranging from about 1% to 7%. Steroids can be an effective treatment, but high doses over a long period of time are often r.

Azithromycin: A New Treatment Hope for Idiopathic Pulmonary Fibrosis?

Feb 22nd, 2018 - Idiopathic pulmonary fibrosis (IPF) is a progressive lung disorder of unknown etiology for which there is no effective therapy. Its course tends to be associated with acute exacerbations, each of which carries a very high risk for mortality. Such events respond only poorly to conventional therapy with high-dose systemic corticosteroids and/or broad-spectrum antibiotics. Recent animal research s...

Misleading Diagnosis of Idiopathic Pulmonary Fibrosis: A Clinical Concern

Feb 13th, 2018 - Diagnosing IPF cannot be solely based on a lung biopsy consistent with UIP. Appropriate diagnosis should consider the clinical presentation; PFT, laboratory findings (including rheumatologic workup), imaging (especially radiographic patterns), and biopsies.

Opioid Epidemic Impacts Patients With Sarcoidosis
Neurology Reviews;

Feb 12th, 2018 - The Foundation for Sarcoidosis Research has issued a press release about a survey on chronic pain, neuropathy, and medications for sarcoidosis patients. The survey provides information related to chronic pain experienced by those living with sarcoidosis and the opioid epidemic.

Pulmonary Fibrosis Foundation offers trial-finding app
Christopher Palmer, MDedge News

Feb 7th, 2018 - The Pulmonary Fibrosis Foundation (PFF) has begun offering a tool to help patients navigate through more than 100 clinical trials aimed at advancing the treatment of pulmonary fibrosis, according to a statement from the Foundation. The new tool, the PFF Clinical Trial Finder allows patients “to filter trials by general categories and locations.

Abatacept Shows Promise for RA-ILD

Feb 1st, 2018 - Action Points Patients with rheumatoid arthritis-associated interstitial lung disease (RA-ILD) may benefit from treatment with abatacept (Orencia), according to a Spanish study of 63 patients. Note that RA-ILD is the second leading cause of death in patients with RA, and the prevalence of RA-ILD has been estimated at up to 44% among patients with RA. Abatacept (Orencia) may be a useful treatmen...

February 2018 Digital Edition

Feb 1st, 2018 - Click here to access the February 2018 Digital Edition. Table of Contents A Year 3 Progress Report on Graduate Medical Education Expansion in the Veterans Choice Act Postpartum Psychosis in a Young VA Patient: Diagnosis, Implications, and Treatment Recommendations Veteran With Alcohol Use Disorder and Acute Pancreatitis Misleading Diagnosis of Idiopathic Pulmonary Fibrosis: A Clinical Concern A.

Comparing arterial ratios may aid risk assessment in IPF
Heidi Splete, MDedge News

Jan 26th, 2018 - An arterial ratio can help identify idiopathic pulmonary fibrosis (IPF) patients with a poor prognosis, suggests the findings of registry data from 50 adults. The ratio of the main pulmonary artery diameter (PA) to the ascending aorta diameter (A) as seen on a chest CT correlates with pulmonary artery pressure, M.

Shorter walk test predicts IPF outcomes
Heidi Splete, MDedge News

Jan 25th, 2018 - The 1-minute walk test is as effective as the 6-minute walk test at predicting transplant-free survival in patients with idiopathic pulmonary fibrosis (IPF), based on data from 179 adults. The findings were presented at the CHEST annual meeting.

Tracheobronchial tree size changes may predict IPF outcomes
Heidi Splete, MDedge News

Jan 17th, 2018 - Changes in tracheobronchial tree size may serve as a practical and noninvasive method for predicting disease severity in patients diagnosed with idiopathic pulmonary fibrosis, according to data from 150 adults. To determine the potential predictive value of tracheobronchial tree changes on mortality, Ankush Ratwani, MD, of Georgetown University, Washington, and colleagues reviewed data from adu.

Irregular Yellow-Brown Plaques on the Trunk and Thighs
Tiffany J. Herd, MD, Ryan Fischer, MD et. al.

Jan 8th, 2018 - The Diagnosis: Necrobiotic Xanthogranuloma A 4-mm punch biopsy was performed for routine stain with hematoxylin and eosin. The differential diagnosis included sarcoidosis, necrobiosis lipoidica, xanthoma disseminatum, and multicentric reticulohistiocytosis.

FDA recommends voluntary recall of Limbrel
Rheumatology News; Dan Watson

Dec 6th, 2017 - The Food and Drug Administration announced on Dec. 4 that it recommends the voluntary recall of Limbrel, a medical food product in capsule form that is currently marketed to “manage the metabolic processes associated with osteoarthritis.

The rise and fall of treatment trials in group 3 pulmonary hypertension: Where do we go from here?

Dec 6th, 2017 - To be included in RISE-IIP, patients were required to have an idiopathic interstitial pneumonia, PH confirmed by RHC with a mPAP ≥ 25 mm Hg, World Health Organization Functional Class 2-4 symptoms, and a forced vital capacity (FVC) ≥ 45% predicted. Pertinent exclusion criteria included significant left-sided heart disease and extent of emphysema greater than fibrosis on HRCT.

Flavocoxid for OA Tied to Life-Threatening Health Problems

Nov 26th, 2017 - The US Food and Drug Administration (FDA) is investigating serious adverse events involving flavocoxid (Limbrel, Primus Pharmaceuticals), a prescription product in capsule form that is marketed as a medical food for the management of metabolic processes associated with osteoarthritis. "While a range of adverse events have been reported, two serious and potentially life-threatening medical condi...

Mortality with HF Readmissions Penalty; A Consistent COMPASS; Diagnosing Sarcoidosis

Nov 17th, 2017 - The big news this week was revision of the blood pressure threshold for hypertension and treatment target from 140/90 to 130/80 mm Hg in guidelines released at the American Heart Association meeting in Anaheim, which no doubt will have ripple effects for some time. Among other talked-about presentations at the meeting were findings on 30-day readmission penalties for hospitals, reported simulta...