A drug-induced sarcoidosis-like reaction (DISR) is a systemic granulomatous reaction that is indistinguishable from sarcoidosis and occurs in temporal relationship with initiation of an offending drug. DISRs typically improve or resolve after the withdrawal of offending drug. Four common categories of drugs that have been associated with the development of a DISR are immune checkpoint inhibitors (ICIs), highly active anti-retroviral therapy (HAART), interferons (IFNs) and tumor necrosis factor alpha antagonists (TNF-alpha antagonists). Similar to sarcoidosis, DISRs do not necessarily require treatment, as they may cause no significant symptoms, quality of life impairment or organ dysfunction. When treatment of a DISR is required, standard anti-sarcoidosis regimens seem to be effective. As a DISR tends to improve or resolve when the offending drug is discontinued, this is another effective treatment for a DISR. However, the offending drug need not be discontinued if it is useful, and anti-granulomatous therapy can be added. In some situations, the development of a DISR may suggest a beneficial effect of the inducing drug. Understanding the mechanisms leading to DISRs may yield important insights into the immunopathogenesis of sarcoidosis.

In specialty clinics, a staff physician is often required to direct patient flow through the clinic and performs all documentation for coding/billing. In response to the workload created by increased patient volume, many specialty clinics have implemented protocols for both disease management and coordinating clinic flow. In this article, we review the literature on using mobile technology to assist with patient care, clinic flow, disease management and documentation/billing. We also describe the development and implementation of a mobile application in our pulmonary clinic designed to automate patient flow, assist the physician in documentation/billing and gather research data including review of initial user data and lessons learned.

Tidal volumes standardized to predicted body weight are recommended for adult mechanical ventilation, but children are frequently ventilated using measured body weight. Our goal is to examine the difference in forced vital capacity (FVC ml/kg) using measured compared to predicted body weight in children.

Sleep apnea is an underdiagnosed condition in patients with heart failure. Efficient identification of sleep apnea is needed as treatment may improve heart failure-related outcomes. Currently, use of portable sleep monitoring in hospitalized patients and those at risk for central sleep apnea is discouraged. This study examined if portable sleep monitoring with respiratory polygraphy can accurately diagnose sleep apnea in patients hospitalized with decompensated heart failure.

Suboptimal continuous positive airway pressure (CPAP) adherence in obstructive sleep apnea (OSA) clinical trials involving predominantly Caucasian males limits interpretability and generalizability. We examined predictors of CPAP adherence in a clinical trial enriched with minorities.

A growing body of evidence supports a bidirectional relationship between post-traumatic stress disorder (PTSD) and sleep disturbances. Fragmented sleep induced by sleep-related breathing disorders, insomnia, and nightmares impacts recovery and treatment outcomes and worsens PTSD symptoms. Despite recent attention, management of these disorders has been unrewarding in the setting of PTSD. This review summarizes the evidence for empirically supported treatments of these sleep ailments as it relates to PTSD including psychotherapeutic and pharmacologic interventions. Recent advances in positive airway pressure technology have made treatment of OSA more acceptable however adherence to CPAP represents a significant challenge. The presence of concomitant insomnia, which engenders psychiatric and medical conditions including depression, suicide, alcohol and substance abuse, can be managed with cognitive behavioral therapy (CBT). Hypnotic agents are considered an alternative therapy but concerns about adverse events and lack of high level evidence supporting their efficacy in PTSD have limited their use to resistant cases or as adjunct to behavioral therapy when the response is less than desirable. Intrusion of nightmares can complicate PTSD treatment and exert serious strain on social, occupational and marital relations. Image rehearsal therapy has shown significant reduction in nightmares intensity and frequency. The success of noradrenergic blocking agents has not been consistent among studies with half reporting treatment failure. An integrated stepped care approach that includes components of both behavioral and pharmacologic interventions customized to patients sleep maladaptive behaviors may offer a solution to delivering accessible, effective, and efficient services for individuals with PTSD.

The optimal modality for re-staging the mediastinum following neoadjuvant therapy for lung cancer remains unclear. Surgical methods are currently considered the reference standard. Herein, we evaluate the role of endosonographic techniques for mediastinal re-staging in lung cancer.

International Classification of Disease (ICD) coding system is broadly utilized by healthcare providers, hospitals, healthcare payers, and governments to track health trends and statistics at the global, national, and local levels and to provide a reimbursement framework for medical care based upon diagnosis and severity of illness. The current iteration of the ICD system, ICD-10, was implemented in 2015. While many changes to the prior ICD-9 system were included in the ICD-10 system, the newer revision failed to adequately reflect advances in the clinical classification of certain diseases such as pulmonary hypertension (PH). Recently, a proposal to modify the ICD-10 codes for PH was considered and ultimately adopted for inclusion as updates to ICD-10 coding system. While these revisions better reflect the current clinical classification of PH, in the future, further changes should be considered to improve the accuracy and ease of coding for all forms of PH.

Parenteral prostanoids are considered the treatment of choice for patients with severe pulmonary arterial hypertension (PAH). Prognostic studies for patients treated in the modern era are limited.

There are many ways in which women experience sleep differently than men. Women contend with distinct sleep challenges, respond differently to sleep disorders, sleep deprivation and deficiency, and face particular health outcomes as a result of poor sleep. Idiosyncrasies - including changes that occur with the biological life cycles of menstruation, pregnancy, and menopause- make the understanding of sleep in women an important topic to study. Each phase of a woman's life, from childhood to menopause, increases the risk of sleep disturbance in unique ways that may require distinct management. Indeed, new research is unraveling novel aspects of sleep pathology in women and the fundamental role that sex hormones play in influencing sleep regulation and arousals and possibly outcomes of sleep conditions. Moreover, studies indicate that during times of hormonal change, women are at an increased risk for sleep disturbances such as poor sleep quality and sleep deprivation as well as sleep disorders such as obstructive sleep apnea, restless legs syndrome and insomnia. This manuscript will review sleep changes in females from the neonatal life to menopause. Sleep and sleep disturbances in women have been gaining attention in recent years as scientists begin to understand the impact of sex as a biological variable on pathology. In 2014, the Society for Women's Health Research convened a group of experts to identify the current state of the science and to identify areas for future research in sleep in women. Multiple gaps were identified in the current literature across sleep disorders. More recently, the Office of Research in Women's Health of the National Institutes of Health, in collaboration with other institutes, organized a workshop "Female Sex and Gender in Lung/Sleep Health and Disease" with the goal of furthering the agenda of the study of sex and gender-specific differences across systems, including sleep. Hence, as sleep changes across the lifespan, understanding sleep in women and its implications is key. This manuscript will review sleep in women across the lifespan and highlight some of the sex differences that are known to exist.

The genesis of dyspnea involves the activation of several mechanisms that are mediated and perceived depending on previous experiences, values, emotions and beliefs. Breathlessness may become unbearable, especially in terminally ill patients, whether afflicted by respiratory, cardiac or cancer-related disorders, due to a final stage of a chronic process, an acute event or both. Compared to pain, palliation of dyspnea has received relatively little attention in clinical practice and the medical literature. This is particularly true when the breathlessness is associated with acute respiratory failure since most of the studies on pharmacological and non-pharmacological treatments of respiratory distress have excluded such patients. Assessments of the quality of dying for patients in an ICU consistently show that few patients are considered by family members to "breathe comfortably" at the end of their life. This Review focuses on the management of dyspnea in patients with advanced terminal illness, summarising clinical trial evidence on pharmacological and non-pharmacologic interventions available for these patients.

Randomized controlled trials at times investigate findings suggested by observational studies. For example, the TORCH trial, which did not show a mortality reduction with inhaled corticosteroids (ICS) in chronic obstructive pulmonary disease (COPD), was motivated by some observational studies that suggested considerable reductions in mortality with these drugs. Reasons for these discrepancies are unclear.

The Publisher regrets that this article is an accidental duplication of an article that has already been published in Eur Respir J. 46 (2015) PA3852, http://dx.doi.org/10.1183/13993003.congress-2015.PA3852. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.

The Publisher regrets that this article is an accidental duplication of an article that has already been published in Eur Respir J. 46 (2015) PA3852, http://dx.doi.org/10.1183/13993003.congress-2015.PA3852. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.

The Publisher regrets that this article is an accidental duplication of an article that has already been published in Eur Respir J. 46 (2015) PA3852, http://dx.doi.org/10.1183/13993003.congress-2015.PA3852. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.

Paracentesis is a commonly performed procedure, and generally considered to be low risk. Despite its overall favorable safety profile, use of ultrasound has been demonstrated to reduce the incidence of complications, especially in higher risk patients. Many individual ultrasound techniques have been described in the literature, each with the goal of making paracentesis safer. This article presents a systematic approach for incorporating many of these tools into bedside practice, and includes a series of illustrative figures and narrated video presentations to demonstrate the techniques described.

Atrial fibrillation (AF) is the most common arrhythmia encountered in the intensive care unit. Pre-existing AF is highly prevalent among older patients with chronic conditions who are at risk for critical illness, while new-onset AF can be triggered by accelerated atrial remodeling and arrhythmogenic triggers encountered during critical illness. The acute loss of atrial systole and onset of rapid ventricular rates that characterize new-onset AF often lead to decreased cardiac output and hemodynamic compromise. Thus, new-onset AF is both a marker of disease severity as well as a likely contributor to poor outcomes - similar to other manifestations organ dysfunction during critical illness. Evaluating immediate hemodynamic effects of new-onset AF during critical illness is an important component of rapid clinical assessment aimed to identify patients in need of urgent direct current cardioversion, treatment of reversible inciting factors, and identification of patients who may benefit from pharmacologic rate or rhythm control. In addition to acute hemodynamic effects, new-onset AF during critical illness is associated with both short and long-term increases in the risk of stroke, heart failure and death, with AF recurrence rates of approximately 50% within 1-year after hospital discharge. In the absence of a strong evidence base, there is substantial practice variation in the choice of strategies for management of new-onset AF during critical illness. We describe acute- and long-term evaluation and management strategies based on current evidence, and propose future avenues of investigation to fill large knowledge gaps in the management of patients with AF during critical illness.

A 77-year-old woman presented to the hospital with symptoms of progressive shortness of breath with associated right-sided pleuritic pain. The patient had begun noting dyspnea on exertion, limiting her ability to go on hikes over the few days prior to admission. Her medical history is significant for carcinoid tumor status postresection in 2012 without recurrence. She has no history of thromboembolism or clotting disorders, and she has no history of smoking or drug abuse. Current medications include amlodipine, celecoxib, hydrochlorothiazide, and rosuvastatin.

A man in his 20s presented with 2 months of mild fatigue and intermittent hemoptysis of less than a tablespoon per episode. He was previously healthy and was on no medications. He denied fevers, night sweats, weight loss, wheezing, dyspnea, musculoskeletal symptoms, and rashes. He had emigrated from a South American country to the United States 3 years earlier. He worked as a groundskeeper but had no exposures to animals, mold, or dusts. He reported rare prior cigarette smoking with no history of alcohol or drug use. He was unsure whether he had received the Bacillus Calmette-Guérin vaccine.

A 64-year-old Latin American woman was referred for evaluation of an incidental pulmonary nodule. She had originally presented to her primary care physician with complaints of abdominal pain warranting a CT scan of the abdomen, which revealed a right lower lobe pulmonary nodule. She denied any complaints of shortness of breath or cough. Review of systems was unremarkable and medical history was significant for hypertension only. She also denied primary or secondary tobacco exposure or any recreational drug abuse. Patient denied any recent travels and resided in Houston, Texas. There was no family history of malignancy or lung disease.