Diffuse cystic lung diseases (DCLDs) are a group of diverse pulmonary disorders with varying pathophysiology that are characterized by the presence of thin-walled, air-filled spaces within lung parenchyma. High-resolution computed tomography plays a crucial role in the evaluation of DCLDs, and cyst characteristics such as morphology, distribution, and the presence of other associated radiologic findings can help distinguish between different DCLDs. DCLDs can be classified according to their underlying pathophysiology as neoplastic, genetic, lymphoproliferative, infectious, associated with other forms of interstitial lung disease, or related to smoking. In this review we will provide a clinical overview on the most common DCLDs that are encountered in clinical practice: lymphangioleiomyomatosis, pulmonary Langerhans cell histiocytosis, Birt-Hogg-Dubé syndrome, and lymphoid interstitial pneumonia/follicular bronchiolitis, with a focus on practical aspects that can help clinicians in the optimal diagnosis and management of patients with DCLDs.
To study the trend of asthma exacerbation readmission rates over the last several years. METHODS: We evaluated the readmission rates for asthma over the last several years to observe the trend of asthma readmissions to the hospital within 30 days of discharge. We present the trends during the time period 2009 to 2013 using data from Healthcare Cost and Utilization Project Nationwide Readmissions Database. A cohort of 1,220,047 asthma hospitalizations of patients older than 18 years was identified in this time period and the 30-day readmission rates were analyzed by comparing rates in consecutive years and the beginning and end of the time period listed using Z-test for proportions.
PURPOSE: To identify and define the population of patients diagnosed with COPD, Emphysema and Chronic Bronchitis in a primary care practice. METHODS: We performed a retrospective chart review of patients with a new diagnosis of COPD, Emphysema or Chronic Bronchitis (ICD-9 491.2, 491.9, 492.8) seen in the primary care practice of Tufts Medical Center from 2001 through 2016. Diagnostic accuracy was determined using clinic notes, pulmonary function testing and chest imaging. Patients were divided into two groups using Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria: COPD and Indeterminate. The COPD group included patients with one or more of the following: an obstructive ventilatory defect on spirometry, radiographic evidence of emphysema, a clinical history consistent with chronic bronchitis. Patients lacking these criteria were Indeterminate. Clinical and diagnostic covariates including age, gender, BMI, comorbidities, smoking history, frequency of pulmonary function testing (PFTs) and pulmonary consultation were compared between the two groups. Data were summarized using means (standard deviations) and n (%) where appropriate. Chi-square and T-test were used for between group comparisons. RESULTS: During the 15 year period, 290 patients seen in the Tufts primary care practice were given a new diagnosis of COPD, Emphysema or Chronic bronchitis. Eighty percent of these patients were correctly diagnosed with COPD (n¼53), Emphysema (n¼152) or Chronic Bronchitis (n¼27). Patients that were Indeterminate (n¼58) had a higher BMI (31.3 AE 7.6 vs. 27.4 AE 6.6, p < 0.0001) and a higher prevalence of a prior Asthma diagnosis (25.9% vs. 8.2%, p < 0.0001). There was no significant difference in age, sex, or primary language between the groups. Pulmonary function testing (45% vs. 74%, p < 0.0001) and pulmonary consultation (41% vs. 65%, p < 0.0009) were significantly less likely to have been performed in the Indeterminate group. CONCLUSIONS: In this academic primary care practice 20% of patients given a new diagnosis of COPD, Emphysema or Chronic Bronchitis were mis-or underdiagnosed as they had not undergone sufficient testing to support the diagnosis. These patients with an Indeterminate diagnosis were more overweight or to have a prior diagnosis of asthma than the COPD patients, implying that alternative diagnoses for their symptoms should be considered. Use of PFTs or pulmonary consultation was interestingly less frequent in this Indeterminate group. These data demonstrate that a significant proportion of patients given the diagnosis of COPD in primary care practices may be mis-identified. This has important implications for provider education, patient outcomes and health services utilization. CLINICAL IMPLICATIONS: Establishing a correct diagnosis of COPD has important implications for individual patients as appropriate clinical interventions can be associated with improved symptoms, functional capacity and quality and duration of life. Proper identification of COPD is also becoming more critical to ...
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