Atherosclerosis is an inflammatory disease. Because high plasma concentrations of cholesterol, in particular those of low-density lipoprotein (LDL) cholesterol, are one of the principal risk factors for atherosclerosis,1 the process of atherogenesis has been considered by many to consist largely of the accumulation of lipids within the artery wall; however, it is much more than that. Despite changes in lifestyle and the use of new pharmacologic approaches to lower plasma cholesterol concentrations,2,3 cardiovascular disease continues to be the principal cause of death in the United States, Europe, and much of Asia.4,5 In fact, the lesions of atherosclerosis represent . . .

https://www.nejm.org/doi/pdf/10.1056/NEJM199901143400207

Atherosclerosis — An Inflammatory Disease

Atherosclerosis is an Inflammatory Disease

This document is an international evidence-based guideline on the diagnosis and management of idiopathic pulmonary fibrosis, and is a collaborative effort of the American Thoracic Society, the European Respiratory Society, the Japanese Respiratory Society, and the Latin American Thoracic Association. It represents the current state of knowledge regarding idiopathic pulmonary fibrosis (IPF), and contains sections on definition and epidemiology, risk factors, diagnosis, natural history, staging and prognosis, treatment, and monitoring disease course. For the diagnosis and treatment sections, pragmatic GRADE evidence-based methodology was applied in a question-based format. For each diagnosis and treatment question, the committee graded the quality of the evidence available (high, moderate, low, or very low), and made a recommendation (yes or no, strong or weak). Recommendations were based on majority vote. It is emphasized that clinicians must spend adequate time with patients to discuss patients' values and preferences and decide on the appropriate course of action.

An Official ATS/ERS/JRS/ALAT Statement: Idiopathic Pulmonary Fibrosis: Evidence-Based Guidelines for Diagnosis and Management

SERIES “ATS/ERS TASK FORCE: STANDARDISATION OF LUNG FUNCTION TESTING” 

Edited by V. Brusasco, R. Crapo and G. Viegi 

Number 5 in this Series 







This section is written to provide guidance in interpreting pulmonary function tests (PFTs) to medical directors of hospital-based laboratories that perform PFTs, and physicians who are responsible for interpreting the results of PFTs most commonly ordered for clinical purposes. Specifically, this section addresses the interpretation of spirometry, bronchodilator response, carbon monoxide diffusing capacity ( D L,CO) and lung volumes.

The sources of variation in lung function testing and technical aspects of spirometry, lung volume measurements and D L,CO measurement have been considered in other documents published in this series of Task Force reports 1–4 and in the American Thoracic Society (ATS) interpretative strategies document 5.

An interpretation begins with a review and comment on test quality. Tests that are less than optimal may still contain useful information, but interpreters should identify the problems and the direction and magnitude of the potential errors. Omitting the quality review and relying only on numerical results for clinical decision making is a common mistake, which is more easily made by those who are dependent upon computer interpretations.

Once quality has been assured, the next steps involve a series of comparisons 6 that include comparisons of test results with reference values based on healthy subjects 5, comparisons with known disease or abnormal physiological patterns ( i.e. obstruction and restriction), and comparisons with self, a rather formal term for evaluating change in an individual patient. A final step in the lung function report is to answer the clinical question that prompted the test.

Poor choices made during these preparatory steps increase the risk of misclassification, i.e. a falsely negative or falsely positive interpretation for a lung function abnormality or a change …

https://erj.ersjournals.com/content/erj/26/5/948.full.pdf

Interpretative strategies for lung function tests

Executive Summary Objectives Participants Evidence Validation Key Messages Introduction Rationale for a Change in the Approach to Classification of Idiopathic Interstitial Pneumonias Development of a New Classification of Idiopathic Interstitial Pneumonia Current Classification of IIP New ATS/ERS Classification Principles Guiding the Assessment of Patients with Idiopathic Interstitial Pneumonias The Diagnostic Process Is Dynamic Clinical Evaluation Radiological Evaluation Role of Surgical Lung Biopsy Unclassifiable Interstitial Pneumonia Bronchoalveolar Lavage Fluid Evaluation Idiopathic Pulmonary Fibrosis Clinical Features Radiologic Features Histologic Features IPF: Areas of Uncertainty Nonspecific Interstitial Pneumonia Clinical Features Radiologic Features Histologic Features NSIP: Areas of Uncertainty Cryptogenic Organizing Pneumonia Clinical Features Radiologic Features Histologic Features COP: Areas of Uncertainty Acute Interstitial Pneumonia Clinical Features Radiologic Features Histologic Features AIP: Areas of Uncertainty Respiratory Bronchiolitis-Associated Interstitial Lung Disease Clinical Features Radiologic Features Histologic Features RB-ILD: Areas of Uncertainty Desquamative Interstitial Pneumonia Clinical Features Radiologic Features Histologic Features DIP: Areas of Uncertainty Lymphoid Interstitial Pneumonia Clinical Features Radiologic Features Histologic Features LIP: Areas of Uncertainty References Appendix

American thoracic society/European respiratory society international multidisciplinary consensus classification of the idiopathic interstitial pneumonias

Episodes of asthma, characterized by bronchial hyper-responsiveness and airway obstruction, are usually reversible and can be mitigated or prevented by appropriate use of therapeutic agents to manage asthma attacks. This article will highlight the various forms of asthma, either chronic or induced, and review both the correlating environmental factors and the immune mechanisms that are now understood to drive the inflammatory processes in the airways of the affected individuals. A significant fraction of humans is genetically predisposed toward having a robust response to allergens, characterized by a strong immunoglobulin E response (termed atopy) that manifests as an asthmatic reaction to airborne allergens in these sensitized individuals. However, occupation chemicals, airborne particles, and common insect allergens at home can also elicit an asthmatic response in exposed individuals, regardless of whether they are genetically susceptible or not. The complex immune mechanisms and sequelae that are associated with, and probably causal to, acute and persistent asthma episodes indicate that an imbalanced immune system is the primary driving force underlying asthma. This article will discuss how a dysregulated immune system, if not controlled by proper and aggressive therapeutic regimens, leads to pathogenic infiltration of the lung by various pro-inflammatory cells and eventual remodeling of the airway tissues, compromising normal lung function and one's quality of life.

A new look at the pathophysiology of asthma.

Cryptogenic Organizing Pneumonia.

ProblemAcademic medical centers (AMCs) and their academic departments are increasingly assuming leadership in the education, science, and implementation of quality improvement (QI) and patient safety efforts. Fostering, recognizing, and promoting faculty leading these efforts is challenging using tr

Early Experiences After Adopting a Quality Improvement Portfolio Into the Academic Advancement Process.

6-Minute Walk Test Distance (6MWD) Is A Reliable, Valid, And Responsive Outcome Measure That Predicts Mortality In Patients With IPF

The event described by Mensah in this issue1 occurred when he was a student at a school known for its commitment to preparing a workforce capable of meeting the needs of our increasingly diverse communities, with faculty committed to using science to solve complex problems for our most vulnerable communities, in a medical educational program with social justice as a foundational pillar. And in this progressive institution, in the context of institutional values that espouse diversity, equity and inclusion, Mensah, a medical student of color, was asked by a faculty member on teaching rounds to explain the use of an abhorrent racial epithet in rap music. Shockingly, the faculty member repeated that epithet several times. We write this commentary to support this student as he gives voice to the experiences of other students of color; to inform our colleagues across the country about destructive and stressful elements of the learning environment that are uniquely felt by students from groups underrepresented in medicine (UIM); to catalyze institutions to rethink systems that make surfacing of events such as this difficult; and to issue an appeal for faculty and administrators in all medical schools to take personal and institutional steps to accelerate the creation of inclusive and equitable environments for learning, discovery, and patient care. The launch of the WhiteCoats4BlackLives (WC4BL) movement in 2014 catalyzed the University of California, San Francisco (UCSF) School of Medicine to focus our 2015 Dean’s Leadership Retreat on issues of race and ethnicity. Courageous learners and faculty members from groups UIM relayed episodes of microaggressions, overtly racist comments, exclusionary behaviors, and other disadvantages that they had faced during their journeys to, through, and beyond medical school. In response, the school launched the Differences Matters Initiative with a goal of accelerating the achievement of a culture of equity, inclusion, and diversity in all mission areas. We have worked to uncover, describe, analyze, and measure the impact of microaggressions, bias, and discrimination experienced by our learners, staff, and faculty. This is some of what we have learned.

Talmadge E. King

Papers

A new look at the pathophysiology of asthma.

Cryptogenic Organizing Pneumonia.

Early Experiences After Adopting a Quality Improvement Portfolio Into the Academic Advancement Process.

6-Minute Walk Test Distance (6MWD) Is A Reliable, Valid, And Responsive Outcome Measure That Predicts Mortality In Patients With IPF

Lessons From an Educational Never Event