Abstract:
:Host defense mechanisms spaced along the respiratory tree and in the alveolar spaces effectively remove or contend with micro-organisms that enter the airways, so serious lung infections occur rarely in healthy people. Special circumstances, such as virgin exposure to a virulent microbe or a large innoculum of a pathogen, can result in illness, but usually routine surveillance host defenses are protective and suffice to keep colonizing airway flora in check. When pneumonia develops or recurrent sinopulmonary infection exists, however, some element of the normal defense apparatus may have failed or is inadequate. This review highlights several components of the apparatus, that is immunoglobulins IgG and IgA and the interaction of alveolar macrophages and lymphocytes, and examines deficiencies in their function that may result in infection. Along the conducting airways, poor mucociliary clearance and/or deficiencies in certain IgG subclass antibodies or destruction of IgA may predispose to sinopulmonary infections; these may be a manifestation of a hereditary disease. In pneumonia the alveolar macrophage is positioned as the central cell which must respond in several directions. This scavenger phagocyte first intercepts the microbe and either can kill or contain it or must call in some other phagocytic cell or inflammatory mediator(s) for assistance. Opsonic antibodies (IgG) and other nonimmune opsonins (complement and surfactant or fibronectin fragments) facilitate phagocytosis, but an absence of antibody may permit infection to develop with encapsulated bacteria (pneumococcus). Insufficient bone marrow reserves of PMNs or a paucity of chemotactic factors to attract them into the alveoli is a situation that may permit gram-negative bacilli and fungal organisms to flourish. Inability of immune T-lymphocytes to energize macrophages, through soluble cellular mediators that provide cell-mediated immunity and activation, makes containment of certain intracellular microbes impossible for these phagocytes (Legionella or mycobacteria). Likewise, concomitant infection of macrophages with viruses (human immunodeficiency virus, and cytomegalovirus or herpes viruses) plus an excessive T-lymphocyte suppressor cell influence may make P. carinii and common bacterial and fungal organisms difficult to contain in the lungs of AIDS patients. Consideration about what the lung host deficiency might be can make therapy more specific through immunization to develop special antibodies, replacement of certain immunoglobulins (IgG subclasses), or selective administration of cell mediators (gamma-interferon or interleukins).
journal_name
Clin Chest Medjournal_title
Clinics in chest medicineauthors
Reynolds HYsubject
Has Abstractpub_date
1987-09-01 00:00:00pages
339-58issue
3eissn
0272-5231issn
1557-8216journal_volume
8pub_type
杂志文章,评审abstract::Cough is a complex physiologic event that protects the lungs from mechanical, chemical, and thermal injury. It is a normal reflex and therefore helps humans to adapt to an ever-changing environment. Cough can also be a pathologic reflex in that it may be an important and often the only sign of serious disease, may sig...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:
更新日期:1987-06-01 00:00:00
abstract::Controversy over the use of inhaled beta-agonists has dated almost from their introduction as a treatment for asthma. Their effectiveness as bronchodilators is not disputed, but there is concern that they may worsen asthma control if used regularly and that excessive use may increase the risk of death from asthma. Fiv...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:
更新日期:1995-12-01 00:00:00
abstract::A multitude of overlapping defenses has evolved to help combat the inventiveness of pathogens seeking to invade us, and because the lung is the most common primary route of infection, it is in the lung that the most varied responses are seen. This article focuses on recent research, particularly in innate immunity, an...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2012.03.003
更新日期:2012-06-01 00:00:00
abstract::ICU-acquired weakness is a common problem and carries significant morbidity. Despite evidence that early mobility can mitigate this, implementation outside of the research setting is lagging. Understanding barriers at the systems as well as individual level is a crucial step in successful implementation of an ICU mobi...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2015.05.006
更新日期:2015-09-01 00:00:00
abstract::The hyperventilation seen in asthma is due to an increase in respiratory drive. This may be reflected by increased neural output to the respiratory muscles and probably by alterations in the respiratory pattern. This increased respiratory drive is most likely in response to irritant receptor stimulation in the lung. O...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:
更新日期:1980-01-01 00:00:00
abstract::Occupational and environmental exposures contribute to the development and progression of most lung diseases, yet their impact is greatly under-recognized in clinical practice. Clinicians caring for patients with respiratory diseases should maintain a high index of suspicion for occupational and environmental contribu...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2020.08.019
更新日期:2020-12-01 00:00:00
abstract::Medications can significantly increase weight loss compared with placebo in most trials. In general, patients can expect a weight loss of 8% to 10% from baseline provided they adhere to the weight-loss program and take medications regularly. All medications have side effects that need to be considered before initiatin...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2009.05.014
更新日期:2009-09-01 00:00:00
abstract::Current advances in guided bronchoscopy methods permit minimally invasive access to essentially any area of the lungs. This provides a potential means to treat patients with localized lung malignancies who might not otherwise tolerate conventional treatment, which commonly relies on surgical resection. Ablation method...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2017.11.014
更新日期:2018-03-01 00:00:00
abstract::Our understanding of chronic bronchitis has been hampered by the fact that the diagnosis is based upon historical evidence of recurrent cough and sputum without any requirement that certain physiologic or microscopic criteria be met. Despite the fact that epidemiological studies have implicated viruses, bacteria, and ...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:
更新日期:1981-01-01 00:00:00
abstract::Delirium is a frequent complication in older patients in the ICU and often persists beyond their ICU stay. Delirium in older persons in the ICU is a dynamic and complex process. There is a high prevalence of pre-existing cognitive impairment in patients who are admitted to the medical ICU. This pre-existing cognitive ...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/s0272-5231(03)00092-3
更新日期:2003-12-01 00:00:00
abstract::This article reviews several important noninfectious pulmonary complications that threaten survival, pulmonary function, and quality of life after lung transplantation. Topics reviewed include primary graft dysfunction (PGD), native lung hyperinflation, anastomotic complications, phrenic nerve injury, pleural complica...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2005.06.006
更新日期:2005-12-01 00:00:00
abstract::This article gives a broad overview of the increasingly important applications of bronchoscopy, flexible (FOB) and rigid (RB), in a modern medical intensive care unit. Special emphasis is made to bronchoscopy use in mechanically ventilated patients. Therapies such as endobronchial stenting and Nd:YAG laser are being u...
journal_title:Clinics in chest medicine
pub_type: 杂志文章
doi:10.1016/s0272-5231(05)70041-1
更新日期:2001-06-01 00:00:00
abstract::The Early Goal-Directed Therapy versus Standard Care for Sepsis trial by Rivers and colleagues in 2001 suggested that a significant mortality reduction may be realized through goal-directed interventions early in the care of patients with septic shock. However, the recent publication of the Protocol-Based Care for Ear...
journal_title:Clinics in chest medicine
pub_type: 评论,杂志文章,评审
doi:10.1016/j.ccm.2016.01.016
更新日期:2016-06-01 00:00:00
abstract::From our studies, it is clear that diaphragm muscle neuromotor control is responsive to alterations in innervation and activation. These adaptations to altered use appear to be most pronounced among fast-twitch motor units composed of type II muscle fibers. Because the plasticity involves diminished contractile streng...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:
更新日期:1994-12-01 00:00:00
abstract::Photodynamic therapy is an investigational treatment of various types of carcinoma. It involves a photosensitizing agent which, when exposed to light of the proper wavelength, forms toxic oxygen radicals that result in cell death. This article describes its current use in the management of bronchogenic carcinoma. ...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:
更新日期:1995-09-01 00:00:00
abstract::Rheumatoid arthritis (RA) is commonly associated with pulmonary disease that can affect any anatomic compartment of the thorax. The most common intrathoracic manifestations of RA include interstitial lung disease, airway disease, pleural disease, rheumatoid nodules, and drug-induced toxicity. Patients with RA with tho...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2019.05.003
更新日期:2019-09-01 00:00:00
abstract::The objectives of this article are to (1) understand how respiratory event definitions and syndrome threshold values affect prevalence estimates of obstructive sleep apnea in adults, (2) recognize important risk factors for obstructive sleep apnea in adults, and (3) understand current theories of the underlying mechan...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2010.02.011
更新日期:2010-06-01 00:00:00
abstract::Endobronchial ablative therapies, such as mechanical debulking, laser therapy, electrocautery, argon plasma coagulation, cryotherapy, brachytherapy, photodynamic therapy, microdebrider bronchoscopy, resector balloon deobstruction, and intratumoral chemotherapy, are performed through a rigid or flexible bronchoscope in...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2017.11.008
更新日期:2018-03-01 00:00:00
abstract::Chronic obstructive pulmonary disease (COPD) has become a major and growing health problem, with a mortality rate that continues to increase. Several factors, have been identified as individual predictors of mortality in COPD. This article reviews individual predictors for mortality. It also discusses the ability of a...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2007.05.002
更新日期:2007-09-01 00:00:00
abstract::As parenchymal lung disease in chronic obstructive pulmonary disease becomes increasingly severe there is a diminishing prospect of drug therapies conferring clinically useful benefit. Lung volume reduction surgery is effective in patients with heterogenous upper zone emphysema and reduced exercise tolerance, and is p...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2013.10.011
更新日期:2014-03-01 00:00:00
abstract::Patients with MAC-PD and pre-existing lung disease are a distinct group from the more common and recently recognized group of predominantly middle- to older-aged women without pre-existing lung disease. Those with pre-existing disease are expected to have more sputum positivity and slower conversion of sputum with tre...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/s0272-5231(02)00022-9
更新日期:2002-09-01 00:00:00
abstract::Recent progress in medical therapies has diminished the role of transplantation in the management of PPH during the past decade. Drug therapy is not effective in some patients, responses to therapy are not sustained over time in others, and drug side effects eventually limit the benefits of treatment in a few more. Lu...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/s0272-5231(05)70293-8
更新日期:2001-09-01 00:00:00
abstract::Recent events have underscored the importance of proper diagnosis and management of patients with inhalation injury. Clinicians who care for individuals who have sustained inhalation damage to their respiratory tract need to take a careful exposure history and be alert to possibilities of delayed effects and clinical ...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/s0272-5231(02)00025-4
更新日期:2002-12-01 00:00:00
abstract::Patient adherence to prescribed tuberculosis regimens must be assured to prevent relapse, acquired resistance, and transmission. Directly observed therapy (DOT), an outpatient management strategy designed to ensure adherence, is not widely used because it is perceived to be inordinately expensive. The primary focus of...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/s0272-5231(05)70365-8
更新日期:1997-03-01 00:00:00
abstract::The combination of the unique pathologic features of usual interstitial pneumonia (UIP) on biopsy, the progressive clinical course, and resistance to anti-inflammatory therapy constitutes the cardinal manifestations of what is termed idiopathic pulmonary fibrosis (IFP)/usual interstitial pneumonia, and it has led to r...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2004.04.003
更新日期:2004-12-01 00:00:00
abstract::Sleep-related breathing disorders are strongly associated with increased risk of stroke independent of known risk factors. The direction of causation favors sleep-disordered breathing leading to stroke rather than the other way around, although definitive proof of this awaits the results of prospective cohort studies....
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/s0272-5231(03)00027-3
更新日期:2003-06-01 00:00:00
abstract::In general, lung involvement in connective tissue disorders has not been as well defined as has isolated interstitial lung disease; this applies particularly to bronchiolitis, which occurs infrequently. The low prevalence of bronchiolitis may reflect difficulties in making the diagnosis in mild to moderate disease; at...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:
更新日期:1993-12-01 00:00:00
abstract::Two recent major guidelines on diagnosis and treatment of ventilator-associated pneumonia (VAP) recommend consideration of local antibiotic resistance patterns and individual patient risks for resistant pathogens when formulating an initial empiric antibiotic regimen. One recommends against invasive diagnostic techniq...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2018.08.002
更新日期:2018-12-01 00:00:00
abstract::HIV-AIDS has disproportionately affected minority populations in the United States. Significant disparities in case rates and mortality have been noted. This article reviews the magnitude of the problem and the many factors involved in the development and perpetuation of these disparities. Possible measures to help co...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2006.04.010
更新日期:2006-09-01 00:00:00
abstract::Sjögren's syndrome is one of the most common systemic rheumatic diseases. Pulmonary disease is prevalent in Sjögren's syndrome; respiratory manifestations include chronic cough, obstructive airways disease, pulmonary lymphoma, and interstitial lung disease that may progress to severe pulmonary fibrosis. ...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/s0272-5231(05)70110-6
更新日期:1998-12-01 00:00:00