News
Mauro Fermariello/Science Photo Library
New guidelines for childhood interstitial lung disease
Published Online August 20, 2013 http://dx.doi.org/10.1016/ S2213-2600(13)70132-2 For the new guidelines see Am J Respir Crit Care Med 2013; 188: 376–94
Childhood interstitial lung disease is different from adult interstitial lung disease and needs specialist diagnosis and management, according to new guidelines from the American Thoracic Society. A multidisciplinary panel developed the guidelines for classification, diagnosis, and management of interstitial lung disease in neonates and infants up to 2 years of age. The recommendations were formulated on the basis of observational evidence and clinical experience because of a scarcity of clinical trial data. There is growing recognition and understanding of novel entities that cause interstitial lung disease in infants, such as genetic mutations in surfactant proteins, notes Geoffrey Kurland (Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA), one of the authors of the guidelines.
Kurland told The Lancet Respiratory Medicine: “We set out to describe the most important of these new entities in childhood interstitial lung disease. We emphasise that their relative rarity means that clinicians should first rule out more common causes of diffuse lung disease in children: cystic fibrosis, immunodeficiency states, viral infections, cardiac causes of diffuse lung disease, and chronic aspiration syndromes.” The guidelines state that once these causes are ruled out, at least three of the following criteria should be present to diagnose childhood interstitial lung disease: respiratory symptoms such as cough, rapid breathing, or exercise intolerance; respiratory signs such as tachypnoea, adventitious sounds, or retractions; and hypoxaemia and diffuse abnormalities on a chest radiograph or CT scan.
Genetic testing, echocardiography, CT scanning, pulmonary function testing, and bronchoalveolar lavage should then be done to establish the exact diagnosis. If these tests fail to identify a cause then a surgical lung biopsy should be done. Stefan Worgall (Weill Cornell Medical College, New York, NY, USA) notes: “These guidelines are helpful because most paediatric pulmonologists are not familiar with these rare diseases. When caring for a patient in this age group who presents with diffuse lung disease it is always a huge challenge to decide the best sequence of diagnostic tests.” “Our paper is merely a beginning in describing an approach to these patients. We need multicentre studies involving patient registries that will allow us to learn the natural history and response to treatment for these diseases”, says Kurland.
Hilary Marshall
Pasieka/Science Photo Library
C-reactive protein could predict pneumonia in COPD
Published Online August 20, 2013 http://dx.doi.org/10.1016/ S2213-2600(13)70135-8 For the study see Chest 2013; published online July 4. DOI:10.1378/chest.13-0488
510
High concentrations of serum C-reactive protein (CRP) could act as a marker for the development of communityacquired pneumonia in patients with chronic obstructive pulmonary disease (COPD), new research suggests. The findings could help clinicians to identify cases of pneumonia that might be missed when results of chest radiographs are inconclusive. Measurement of CRP concentrations could also decrease the need for CT and reduce the prescription of unnecessary antibiotics. For the new study, researchers examined the inflammatory profile of 249 patients with COPD, of whom 133 had an acute exacerbation and 116 had community-acquired pneumonia. Blood biomarkers, including CRP concentrations, were measured on admission to hospital, after day 3, and then 30 days after admission.
The researchers identified two different inflammatory profiles in patients admitted to hospital with COPD. Patients with COPD and pneumonia had higher CRP concentrations (p
Mauro Fermariello/Science Photo Library
New guidelines for childhood interstitial lung disease
Published Online August 20, 2013 http://dx.doi.org/10.1016/ S2213-2600(13)70132-2 For the new guidelines see Am J Respir Crit Care Med 2013; 188: 376–94
Childhood interstitial lung disease is different from adult interstitial lung disease and needs specialist diagnosis and management, according to new guidelines from the American Thoracic Society. A multidisciplinary panel developed the guidelines for classification, diagnosis, and management of interstitial lung disease in neonates and infants up to 2 years of age. The recommendations were formulated on the basis of observational evidence and clinical experience because of a scarcity of clinical trial data. There is growing recognition and understanding of novel entities that cause interstitial lung disease in infants, such as genetic mutations in surfactant proteins, notes Geoffrey Kurland (Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA), one of the authors of the guidelines.
Kurland told The Lancet Respiratory Medicine: “We set out to describe the most important of these new entities in childhood interstitial lung disease. We emphasise that their relative rarity means that clinicians should first rule out more common causes of diffuse lung disease in children: cystic fibrosis, immunodeficiency states, viral infections, cardiac causes of diffuse lung disease, and chronic aspiration syndromes.” The guidelines state that once these causes are ruled out, at least three of the following criteria should be present to diagnose childhood interstitial lung disease: respiratory symptoms such as cough, rapid breathing, or exercise intolerance; respiratory signs such as tachypnoea, adventitious sounds, or retractions; and hypoxaemia and diffuse abnormalities on a chest radiograph or CT scan.
Genetic testing, echocardiography, CT scanning, pulmonary function testing, and bronchoalveolar lavage should then be done to establish the exact diagnosis. If these tests fail to identify a cause then a surgical lung biopsy should be done. Stefan Worgall (Weill Cornell Medical College, New York, NY, USA) notes: “These guidelines are helpful because most paediatric pulmonologists are not familiar with these rare diseases. When caring for a patient in this age group who presents with diffuse lung disease it is always a huge challenge to decide the best sequence of diagnostic tests.” “Our paper is merely a beginning in describing an approach to these patients. We need multicentre studies involving patient registries that will allow us to learn the natural history and response to treatment for these diseases”, says Kurland.
Hilary Marshall
Pasieka/Science Photo Library
C-reactive protein could predict pneumonia in COPD
Published Online August 20, 2013 http://dx.doi.org/10.1016/ S2213-2600(13)70135-8 For the study see Chest 2013; published online July 4. DOI:10.1378/chest.13-0488
510
High concentrations of serum C-reactive protein (CRP) could act as a marker for the development of communityacquired pneumonia in patients with chronic obstructive pulmonary disease (COPD), new research suggests. The findings could help clinicians to identify cases of pneumonia that might be missed when results of chest radiographs are inconclusive. Measurement of CRP concentrations could also decrease the need for CT and reduce the prescription of unnecessary antibiotics. For the new study, researchers examined the inflammatory profile of 249 patients with COPD, of whom 133 had an acute exacerbation and 116 had community-acquired pneumonia. Blood biomarkers, including CRP concentrations, were measured on admission to hospital, after day 3, and then 30 days after admission.
The researchers identified two different inflammatory profiles in patients admitted to hospital with COPD. Patients with COPD and pneumonia had higher CRP concentrations (p
