The purpose of this review is to summarize what is currently known regarding two important questions facing the field of sleep medicine today: 1) How many hours of continuous positive airway pressure (CPAP) use per night are necessary to improve daytime symptoms and reduce cardiovascular risk associated with obstructive sleep apnea (OSA)?; and 2) What strategies could be implemented to optimize adherence in clinical settings? Despite the widespread adoption of a threshold approach to CPAP management, the literature to date suggests a dose-response relationship between CPAP usage and a range of outcomes including sleepiness, functional status, and blood pressure, and that the optimal adherence level differs depending on the outcome in question. Over the years, psychological measures of behavior change constructs have been increasingly recognized as the most consistent predictors of CPAP adherence, and as such, the most successful interventions for optimizing adherence have been behavioral in nature. Unfortunately, behavioral therapies have not been translated from highly-controlled research settings to comparative-effectiveness studies and finally into routine care, mainly due to feasibility and cost issues. More recently, theory-driven telemedicine adherence interventions have emerged which take advantage of the framework that already exists in the United States for real-time remote-monitoring of CPAP. Combining theory-driven behavioral approaches with telemedicine technology could hold the answer to increasing real-world CPAP adherence rates, although randomized studies are still required, and socioeconomic barriers to telemedicine will need to be addressed in order to promote health equity.

The Lung Allocation Score (LAS) prioritizes lung transplant (LTx) candidates with poor transplant-free survival and expected survival benefit from LTx. Although patients with the highest LAS have the shortest waiting time, mortality benefit is unclear in this group, raising criticism that LAS inappropriately prioritizes critically ill candidates. We aim to identify a threshold above which increasing LAS values do not predict increasing survival benefit.

There is limited knowledge on what proportions of COPD patients receive ambulatory care from primary care physicians, pulmonologists, or other specialists. We evaluated the types and combinations of physicians that provide ambulatory care to COPD patients.

To review systematically the published literature regarding the impact of treatment for obstructive sleep apnea (OSA) on monetized health economic outcomes.

Intrapleural lytic therapy has been established as an important modality of treatment for many pleural disorders, including hemothorax and empyema. Retained traumatic hemothorax is a common and understudied subset of pleural disease. Current standard of care for retained traumatic hemothorax is operative management. The use of lytic therapy for avoidance of operative intervention in the trauma population has not been well established.

Fibrotic interstitial lung diseases have a high mortality rate with an unpredictable disease course and clinical features that frequently overlap. Recent data indicate important roles for genomics in the mechanisms underlying susceptibility and progression of pulmonary fibrosis, and the impact of these genomic markers on pharmacotherapy and their contribution to outcomes is increasingly recognized. Interstitial lung abnormalities, frequently considered representative of early interstitial lung disease (ILD), have been consistently associated with the MUC5B promoter polymorphism, a common gene variant. Other rare gene variant mutations including TERT, TERC, SFTPC, and DKC1 may be present in patients with familial interstitial pneumonia and are frequently associated with a usual interstitial pneumonia pattern of fibrosis. The minor allele of the MUC5B rs35705950 genotype is prevalent in several sporadic forms of ILD, including idiopathic pulmonary fibrosis, and chronic hypersensitivity pneumonitis. Gene mutations that characterize familial pulmonary fibrosis may be present in patients with connective tissue disease-related ILD, such as rheumatoid arthritis-ILD. Additionally, shorter telomere lengths and mutations in telomere biology-related genes have been demonstrated in both familial and sporadic ILD, with significant implications for disease progression, lung function, and survival. An improved understanding of the impact of genetic and genomic risk factors on disease progression would better guide personalized therapeutic choices in persons with fibrotic ILD.

Effective management of protracted bacterial bronchitis (PBB) is needed to prevent chronic disease (e.g. bronchiectasis). Understanding the contributions of on-going airway infection and inflammation is important to achieving optimal PBB treatments. The aim of this study was to compare bronchoalveolar lavage (BAL) microbiota, bacterial biomass and inflammatory markers in children with PBB and age-matched controls.

In lymphangioleiomyomatosis (LAM), infiltration of the lungs with smooth muscle-like LAM cells results in cystic destruction and decline in lung function, effects stabilized by sirolimus therapy. LAM lung disease is followed, in part, by high-resolution computed tomography scans. To obtain further information from these scans, we quantified changes in lung parenchyma by analyzing image "texture".

Pulmonary arterial hypertension (PAH) carries a poor prognosis if not promptly diagnosed and appropriately treated. The development and approval of 14 medications over the last several decades has led to a rapidly evolving approach to therapy, and has necessitated periodic updating of evidence-based treatment guidelines. This guideline statement, which now includes a visual algorithm to enhance its clinical utility, represents the 4 iteration of the American College of Chest Physicians Guideline and Expert Panel Report on Pharmacotherapy for PAH.

Genetic variants are associated with altered clinical outcome of patients with sepsis and cardiovascular diseases. Common gene signaling pathways may be involved in the pathophysiology of these diseases. A better understanding of genetic commonality among these diseases may enable the discovery of important genes, signaling pathways and therapeutic targets for these diseases. We investigated the common genetic factors by a systematic search of the literature. 24 genes (ADRB2, CD14, FGB, FV, HMOX1, IL1B, IL1RN, IL6, IL10, IL17A, IRAK1, MASP2, MBL, MIR608, MIF, NOD2, PCSK9, PPARG, PROC, SERPINE1, SOD2, SVEP1, TF, TIRAP, TLR1) were extracted as reported genetic variations associated with altered outcome of both sepsis and cardiovascular diseases. Of the 24 genes, the adverse allele (or combinations) was same in 9 genes (ADRB2, FV, HMOX1, IL6, MBL, MIF, NOD2, PCSK9, SERPINE1), and the effect appears to be in the same direction in both sepsis and cardiovascular disease. Shared gene signaling pathways suggest that these are true biological results and could point to overlapping drug targets in sepsis and cardiovascular disease.

Inhaled corticosteroid (ICS)/long-acting β-agonist (LABA) combination commonly prescribed to treat chronic obstructive pulmonary disease (COPD). Therefore, we performed a meta-analysis on the impact of adding a long-acting muscarinic receptor antagonist (LAMA) to ICS/LABA combination in COPD.

Hierarchical condition categories (HCCs) are groups of diagnostic codes that are used to adjust federal payments to insurers and health systems based on differences in expected spending. Risk models built on HCCs improve on previous adjustment strategies that used demographic characteristics but did not include clinical diagnoses. Thus, accurate coding by clinicians of inpatient and outpatient encounters ensures capitated payments and reimbursements that are commensurate with predicted expenditures. Pulmonary diseases and various forms of critical illness play a significant role in this risk adjustment process both through their associated HCC codes and through interactions with other risk categories representing cardiac and psychiatric diseases. Ongoing uncertainty in federal health policy ensures a changing role for HCCs and risk-adjusted reimbursements across a variety of payment models and federal programs.

Bioelectrical impedance analysis is a valuable method for estimating fat-free mass (FFM) and fat mass (FM) in COPD patients by means of specific predictive equations. In addition, raw BIA variables such as high to low frequency impedance ratios (IRs) and phase angle, most likely as a result of providing information on muscle quality, have been related to disease severity and mortality in patients suffering from several diseases, but never in COPD. The aim of this study was to investigate the predictive role of raw BIA variables on two-year survival in COPD.

Human rhinoviruses (RV) are picornaviruses that can cause a variety of upper and lower respiratory tract illnesses including the common cold, bronchitis, pneumonia, and exacerbations of chronic respiratory diseases such as asthma. There are currently over 160 known types of RV classified into three species (A, B and C) that use three different cellular membrane glycoproteins expressed in the respiratory epithelium to enter the host cell. These viral receptors are intercellular adhesion molecule 1 (ICAM-1, used by the majority of RV-A and all RV-B), low density lipoprotein receptor (LDLR) family members (used by 12 RV-A types) and cadherin-related family member 3 (CDHR3, used by RV-C). RV-A and B interactions with ICAM-1 and LDLR glycoproteins are well defined and their cellular functions are described, while mechanisms of RV-C interaction with CDHR3 and its cellular functions are under study. A single nucleotide polymorphism (SNP rs6967330) in CDHR3 increases cell surface expression of this protein, and as a result also promotes RV-C infections and illnesses. There are currently no approved vaccines or antiviral therapies available to treat or prevent RV infections, which is a major unmet medical need. Understanding interactions between RV and cellular receptors could lead to new insights into the pathogenesis of respiratory illnesses, and lead to new approaches to control respiratory illnesses caused by RV infections.

In culture-positive nosocomial pneumonia, de-escalation (DE) from broad-spectrum empirical antimicrobials to narrower-spectrum agents has shown to decrease broad-spectrum antibiotic use without compromising patient outcomes. However, uncertainty exists regarding the safety of anti-methicillin-resistant Staphylococcus aureus (MRSA) agent DE in culture-negative nosocomial pneumonia. This study aimed to determine if anti-MRSA agent DE in culture-negative nosocomial pneumonia affects 28-day and hospital mortality, ICU and hospital length of stay (LOS), treatment failure, and safety.

A 35-year-old woman came to the ED following 2 days of chest pain. She was a nonsmoker, taking no medications, and not using a contraceptive pill. The patient had no history of recent travel but had given birth (full-term pregnancy) 4 months earlier. She described nonradiating, left-sided pleuritic chest pain with no associated dyspnea, cough, sputum, or sweating.

A 3-year-old girl was referred to a pediatric pulmonologist for dyspnea and recurrent upper respiratory tract infections (RTIs). The patient was born full term to unrelated Dutch parents after an uneventful pregnancy and birth. The year before presentation, she had suffered from pneumonia and > 10 upper RTIs. Apart from the recurrent RTIs, which started in infancy, her medical history was not significant and did not include allergies or eczema. An adenotonsillectomy was performed at the age of 2 years, and she was treated with multiple antibiotic regimens and inhalation therapy with salbutamol and corticosteroids, with no relief of symptoms.

Bronchiolitis obliterans (BO) is a significant life-threatening complication that occurs after allogeneic hematopoietic stem cell transplantation (allo-HSCT), and it is associated with increased morbidity and mortality. BO responds poorly to corticosteroids or immunosuppressants, and there are currently no established treatment approaches. We herein describe a patient with biopsy-proven BO after allo-HSCT who was successfully treated with tamibarotene, a novel synthetic retinobenzoic acid. Tamibarotene led to a dramatic improvement in lung function as well as cutaneous manifestations of chronic graft-vs-host disease. A large prospective clinical trial is therefore warranted to confirm the efficacy of tamibarotene in BO.