Geert M. Verleden, MD, PhD, FERS. Medical Director Leuven Lung Transplant Program
|
|
|
- Jason Melton
- 5 years ago
- Views:
Transcription
1 Geert M. Verleden, MD, PhD, FERS Medical Director Leuven Lung Transplant Program
2 History of BOS A working formulation for the standardization of nomenclature and for clinical staging of Chronic C Dysfunction D in L Lung Allografts. A International Society for Heart and Lung Transplantation. Cooper J et al. J Heart Lung Transplant 1993; 12:
3 BOS update Estenne et al. J Heart Lung Transplant 2002; 21:
4 2nd revised BOS update. AN INTERNATIONAL ISHLT/ATS/ERS CLINICAL PRACTICE GUIDELINE: DIAGNOSIS AND MANAGEMENT OF BRONCHIOLITIS OBLITERANS SYNDROME Chair: Keith C. Meyer, MD, MS, University of WI School of Medicine and Public Health, Madison, WI, USA Co-Chairs: Ganesh Raghu, MD, University of Washington School of Medicine, Seattle, WA, USA Geert Verleden, MD, University of Leuven, Belgium Paul Corris, MD, Freeman Hospital, Newcastle upon Tyne, UK Allan Glanville, Sydney, Australia Paul Aurora, MD, MRCP, PhD, Great Ormond Street Hospital for Children, London, UK Jim J. Egan, MD, Dublin, Ireland Meyer KC, Raghu G, Verleden GM et al. Eur Respir J 2014; 44:
5 Up to now BOS diagnosis based on Obstructive spirometry Usually non-reversible Usually progressive Several established risk factors CAT scan may show different patterns Verleden GM et al. Transplant Int 2015, in press
6 07/01/ /05/ /09/ /01/ /05/ /09/ /01/ /05/ /09/ /01/ /05/ /09/ /01/2006 FEV1, L 4 BOS O-p BOS 1 BOS 2 BOS 3 3,5 3 2,5 2 1,5 1 0,5 0 Postoperative time
7 CAT scan expiratory air trapping bronchiectasis/tree-in-bud
8 Pathophysiology of BOS Col V T h 17 Air pollution LB Adapted from Vanaudenaerde et al. Inflamm Allergy Drug Targets 2008;7:
9 Upcoming problems with current BOS definition Reversibility/normalisation of pulmonary function with specific treatments resulting in survival differences after BOS diagnosis
10 Role of fundoplication case report of 23 y old male with CF reversible "allograft dysfunction" bronchiectasis in lower lung lobes no OB on biopsy Palmer et al. Chest 2000.
11 Introduction of azithromycin ESW ratg FK + MMF ratg BOS 2 Time after HLTx Verleden et al. Eur Respir J 2005
12 ESW FEV1 ratg FK + MMF ratg BOS 2 Time after HLTx
13 Gerhardt et al. AJRCCM, 2003 Role of azithromycin Mean increase In FEV1: 17%
14 Verleden S et al. JHLT 2013; 32: Role of BAL NF and IL17 in BOS Correlation % BAL NF and IL-17 + Cells R=0.39 P=0.03
15 BOS/OB microct analysis Courtesy of S. Verleden
16 BOS/OB microct Pathology
17 BOS Phenotypes Characteristic Neutrophilic reversible allograft dysfunction (NRAD-ARAD) Non-neutrophilic BOS Bronchoalveolar Lavage Excess neutrophils (>15%) Neutrophils < 15% Clinic Coarse crackles, increased sputum production No crackles, no sputum Time of Onset Early after transplantation (<1y) Later (> 1y) Progression Slow (several years) Rapid (<6-12 months) Histology Inflammatory, ends up in fibrosis Pure fibrosis (?) Radiology airway wall thickening, mucus plugging, bronchiectasis Air trapping, consolidation Effect of azithromycin Improvement of FEV 1 (reversible) No effect on FEV 1 (irreversible) Adapted from Vanaudenaerde et al. Eur Respir J 2008; 32:
18 AZI-resistant BAL neutrophilia?
19 Neutrophilic Azi-resistant BOS / NAR: prognosis Vandermeulen et al; ERS 2013.
20 BOS phenotypes Characteristic NRAD/ARAD AZI-resistant neutrophilic BOS Bronchoalveolar Lavage Clinic Excess neutrophils (>15%), IL-17 dependent Coarse crackles, increased sputum production Excess neutrophils (> 15%) IL-17 independent Crackles, velcro rales, sputum production Non-neutrophilic BOS Neutrophils < 15% No crackles, no sputum Time of Onset Early after transplantation (<1y) Later > 1 y) Later (> 1y) Progression Slow (several years) Moderate, fast Rapid (<6-12 months) Histology Radiology Inflammatory, ends up in fibrosis, LB airway wall thickening, mucus plugging, bronchiectasis Effect of azithromycin Improvement of FEV 1 (reversible) Inflammation, fibrosis, LB TIB, mucus plugging, brect No effect on FEV 1, role of ECP? Pure fibrosis (?) Air trapping, consolidation No effect on FEV 1 (irreversible) Adapted from Vanaudenaerde et al. and Vandermeulen et al.
21 Variations in BOS Acute onset Chronic onset? Jackson CH et al. J Heart Lung Transplant 2002;21:
22 Upcoming problems with current BOS definition Reversibility/normalisation of pulmonary function with specific treatments resulting in survival differences after BOS diagnosis Other CAT findings, so far not explained In combination with a restrictive pulmonary function defect
23 RAS: a new phenotype of lung allograft dysfunction Sato et al. JHLT 2011
24 Diagnosis of RAS: an unsolved problem? Verleden SE et al. J Heart Lung Transplant 2015, in press.
25 CT scan in RAS Pleuro parenchymal fibro-elastosis like interstitial fibrosis like
26 Micro-CT vs histology: RAS Courtesy of S. Verleden
27 Pathology of RAS Verleden S et al. Sem Respir Crit Care Med 2013, 34:
28 1m 3m 6m BOS may preceed RAS L 6 5 BOS FVC FEV1 FEV1/FVC 0
29 1m 3m 6m BOS may preceed RAS L 6 5 BOS FVC FEV1 FEV1/FVC 0
30 1m 3m 6m BOS may preceed RAS L 6 5 BOS FVC FEV1 FEV1/FVC 0
31 Prognosis of different phenotypes Sato et al. J Heart Lung Transplant 2011; 30: Verleden et al. Transplantation 2011; 92: 703-8
32 Characteristic Bronchoalveolar Lavage CLAD phenotypes NRAD/ARAD Excess neutrophils (>15%), IL-17 dependent AZI-resistant neutro BOS / NAR Excess neutrophils (> 15%) IL-17 independent BOS Non-neutrophilic BOS Neutrophils < 15% RAS Varying neutrophilia (mostly increased), eosinophilia? Clinic Coarse crackles, increased sputum production Crackles, velcro rales, sputum production No crackles, no sputum Normal/velcro rales Time of Onset Early after transplantation (<1y) Later > 1 y) Later (> 1y) Later (>1-2 y) Progression Slow (several years) Moderate, fast Rapid (<6-12 months) Very rapid in most pts Histology Inflammatory, ends up in fibrosis, LB Inflammation, fibrosis, LB Pure fibrosis (?) OB/fibrosis Radiology airway wall thickening, mucus plugging, bronchiectasis TIB, mucus, brect Air trapping, consolidation Air trapping, persistent infiltrates Effect of azithromycin Improvement of FEV 1 (reversible) No effect on FEV 1, role of ECP? No effect on FEV 1 (irreversible) No effect Adapted from Vanaudenaerde et al. Eur Respir J 2008.
33 CLAD and different rejection phenotypes: a proposal Verleden GM et al. J Heart Lung Transplant 2014; 33:
34 CLAD and different rejection phenotypes: a proposal
35 Verleden GM et al. J Heart Lung Transplant 2014; 33: CLAD and different rejection phenotypes: a proposal
36 Schematic CLAD overview CLAD due to specific non-rejection causes Allograft-related -Persistent acute rejection -Infection -Anastomotic stricture -Disease recurrence Extra-allograft-related -Pleural disease -Diaphragm dysfunction -Native lung hyperinflation -Other causes CLAD= Persistent >20% decrease in FEV 1 and/or FVC, compared to the best postoperative baseline and despite a trial with azithromycine for at least 2-3 months
37 Schematic CLAD overview BOS Including NAR BOS CLAD due to specific non-rejection causes Allograft-related -Persistent acute rejection -Infection -Anastomotic stricture -Disease recurrence Extra-allograft-related -Pleural disease -Diaphragm dysfunction -Native lung hyperinflation -Other causes CLAD= Persistent >20% decrease in FEV 1 and/or FVC, compared to the best postoperative baseline and despite a trial with azithromycine for at least 2-3 months
38 Schematic CLAD overview ARAD BOS Including NAR BOS CLAD due to specific non-rejection causes Allograft-related -Persistent acute rejection -Infection -Anastomotic stricture -Disease recurrence Extra-allograft-related -Pleural disease -Diaphragm dysfunction -Native lung hyperinflation -Other causes CLAD= Persistent >20% decrease in FEV 1 and/or FVC, compared to the best postoperative baseline and despite a trial with azithromycine for at least 2-3 months
39 Phenotypes might still change
40 Conclusions CLAD is better than BOS to describe chronic FEV 1 decline after lung transplantation Further subphenotyping using BAL (neutrophilia), extended pulmonary function testing and CT scan is very important Identifying NRAD/ARAD may imply restoration of FEV 1 after adequate treatment with azi and should always be attempted when CLAD is suspected Exact diagnostic phenotype of CLAD may determine survival with RAS having the worst prognosis This proposal will need constant adaptation
41 Thanks Medics Lieven Dupont Dirk Van Raemdonck Robin Vos Jonas Yserbyt UZ Leuven pulmonology and surgical team Erik Verbeken (pathology) Tx Nurses Christel Jans Kris Rosseel Veronique Schaevers Mieke Meelbergs Inge Renquin Annemieke Schoonis E 650 paramedics BOF-ZAP Bart Vanaudenaerde Post Doc Stijn Verleden PhD Students David Ruttens Elly Vandermeulen Hannelore Bellon Jana Somers
Lung Allograft Dysfunction
Lung Allograft Dysfunction Carlos S. Restrepo M.D. Ameya Baxi M.D. Department of Radiology University of Texas Health San Antonio Disclaimer: We do not have any conflict of interest or financial gain to
Current views on chronic rejection after lung transplantation
Transplant International ISSN 0934-0874 REVIEW Current views on chronic rejection after lung transplantation Geert M. Verleden, 1,2 Robin Vos, 1,2 Bart Vanaudenaerde, 1 Lieven Dupont, 1,2 Jonas Yserbyt,
Linking clinical phenotypes of chronic lung allograft dysfunction to changes in lung structure
ERJ Express. Published on June 25, 2015 as doi: 10.1183/09031936.00010615 ORIGINAL ARTICLE IN PRESS CORRECTED PROOF Linking clinical phenotypes of chronic lung allograft dysfunction to changes in lung
Linking clinical phenotypes of chronic lung allograft dysfunction to changes in lung structure
ORIGINAL ARTICLE LUNG TRANSPLANTATION Linking clinical phenotypes of chronic lung allograft dysfunction to changes in lung structure Stijn E. Verleden 1, Dragoş M. Vasilescu 2, John E. McDonough 1,2, David
Advanced Medicine 2016 Lung Transplantation. Paul A Corris Newcastle University Newcastle Upon Tyne UK
Advanced Medicine 2016 Lung Transplantation Paul A Corris Newcastle University Newcastle Upon Tyne UK First Human Lung Transplantation 1963 JAMA 1963;186:1065-74 The lung donor was a NHBD who died from
Progression pattern of restrictive allograft syndrome after lung transplantation
http://www.jhltonline.org FEATURED ARTICLES Progression pattern of restrictive allograft syndrome after lung transplantation Masaaki Sato, MD, PhD, a,b David M. Hwang, MD, PhD, a Thomas K. Waddell, MD,
PNEUMOCONIOSES DIAGNOSIS, DIFFERENTIAL DIAGNOSIS AND TREATMENT. Carlos Robalo Cordeiro
PNEUMOCONIOSES DIAGNOSIS, DIFFERENTIAL DIAGNOSIS AND TREATMENT Carlos Robalo Cordeiro carlos.crobalo@gmail.com Diagnosis 1 History of sufficient exposure to dust, in time and intensity/either occupational
A CASE OF UNFORTUNATE
A CASE OF UNFORTUNATE TAPER Hélène Schoemans, MD University Hospitals Leuven, Belgium EBMT Complications and Quality of Life Working Party Educational Course Warsaw, October 24 th 2014 Company name No
Bile Acids Aspiration Reduces Survival in Lung Transplant Recipients with BOS Despite Azithromycin
American Journal of Transplantation 2011; 11: 329 335 Wiley Periodicals Inc. C 2011 The Authors Journal compilation C 2011 The American Society of Transplantation and the American Society of Transplant
4.6 Small airways disease
4.6 Small airways disease Author: Jean-Marc Fellrath 1. INTRODUCTION Small airways are defined as any non alveolated and noncartilaginous airway that has an internal diameter of 2 mm. Several observations
Antibody Mediated Rejection (AMR) in LUNG TRANSPLANT Recipients
Antibody Mediated Rejection (AMR) in LUNG TRANSPLANT Recipients Lorriana Leard, MD UCSF Transplant Pulmonologist Associate Professor of Clinical Medicine Vice Chief of Clinical Activities Pulmonary, Critical
Asthma COPD Overlap (ACO)
Asthma COPD Overlap (ACO) Dr Thomas Brown Consultant Respiratory Physician Thomas.Brown@porthosp.nhs.uk Dr Hitasha Rupani Consultant Respiratory Physician Hitasha.rupani@porthosp.nhs.uk What is Asthma
Outline FEF Reduced FEF25-75 in asthma. What does it mean and what are the clinical implications?
Reduced FEF25-75 in asthma. What does it mean and what are the clinical implications? Fernando Holguin MD MPH Director, Asthma Clinical & Research Program Center for lungs and Breathing University of Colorado
Mai ElMallah,MD Updates in Pediatric Pulmonary Care XII: An Interdisciplinary Program April 13, 2012
Mai ElMallah,MD Updates in Pediatric Pulmonary Care XII: An Interdisciplinary Program April 13, 2012 Recognize the importance of Pulmonary Function Testing in Cystic Fibrosis Be aware of different types
Bronchiectasis in Adults - Suspected
Bronchiectasis in Adults - Suspected Clinical symptoms which may indicate bronchiectasis for patients Take full respiratory history including presenting symptoms, past medical & family history Factors
Differential diagnosis
Differential diagnosis The onset of COPD is insidious. Pathological changes may begin years before symptoms appear. The major differential diagnosis is asthma, and in some cases, a clear distinction between
11/10/2014. Multi-disciplinary Approach to Diffuse Lung Disease: The Imager s Perspective. Radiology
Multi-disciplinary Approach to Diffuse Lung Disease: The Imager s Perspective Radiology Pathology Clinical 1 Role of HRCT Diagnosis Fibrosis vs. inflammation Next step in management Response to treatment
ASTHMA-COPD OVERLAP SYNDROME 2018: What s All the Fuss?
ASTHMA-COPD OVERLAP SYNDROME 2018: What s All the Fuss? Randall W. Brown, MD MPH AE-C Association of Asthma Educators Annual Conference July 20, 2018 Phoenix, Arizona FACULTY/DISCLOSURES Randall Brown,
What do pulmonary function tests tell you?
Pulmonary Function Testing Michael Wert, MD Assistant Professor Clinical Department of Internal Medicine Division of Pulmonary, Critical Care, and Sleep Medicine The Ohio State University Wexner Medical
INTERSTITIAL LUNG DISEASE. Radhika Reddy MD Pulmonary/Critical Care Long Beach VA Medical Center January 5, 2018
INTERSTITIAL LUNG DISEASE Radhika Reddy MD Pulmonary/Critical Care Long Beach VA Medical Center January 5, 2018 Interstitial Lung Disease Interstitial Lung Disease Prevalence by Diagnosis: Idiopathic Interstitial
Differential diagnosis
Differential diagnosis Idiopathic pulmonary fibrosis (IPF) is part of a large family of idiopathic interstitial pneumonias (IIP), one of four subgroups of interstitial lung disease (ILD). Differential
Case Presentations in ILD. Harold R. Collard, MD Department of Medicine University of California San Francisco
Case Presentations in ILD Harold R. Collard, MD Department of Medicine University of California San Francisco Outline Overview of diagnosis in ILD Definition/Classification High-resolution CT scan Multidisciplinary
ERS School Course Programme Lung Transplantation: Sharing Experience Across Europe February 23-25, 2012 Strasbourg, France
ERS School Course Programme Lung Transplantation: Sharing Experience Across Europe February 23-25, 2012 Strasbourg, France Day 1: Thursday, Date 23. 02. 2012 08:30 08:45 Registration 08:45 09:00 Welcome
5/9/2015. Multi-disciplinary Approach to Diffuse Lung Disease: The Imager s Perspective. No, I am not a pulmonologist! Radiology
Multi-disciplinary Approach to Diffuse Lung Disease: The Imager s Perspective No, I am not a pulmonologist! Radiology Pathology Clinical 1 Everyone needs a CT Confidence in diagnosis Definitive HRCT +
What is Cystic Fibrosis? CYSTIC FIBROSIS. Genetics of CF
What is Cystic Fibrosis? CYSTIC FIBROSIS Lynne M. Quittell, M.D. Director, CF Center Columbia University Chronic, progressive and life limiting autosomal recessive genetic disease characterized by chronic
Respiratory Disease. Dr Amal Damrah consultant Neonatologist and Paediatrician
Respiratory Disease Dr Amal Damrah consultant Neonatologist and Paediatrician Signs and Symptoms of Respiratory Diseases Cardinal Symptoms Cough Sputum Hemoptysis Dyspnea Wheezes Chest pain Signs and Symptoms
FVC to Slow Inspiratory Vital Capacity Ratio* A Potential Marker for Small Airways Obstruction
Original Research PSYCHOLOGICAL TESTING FVC to Slow Inspiratory Vital Capacity Ratio* A Potential Marker for Small Airways Obstruction Judith Cohen, MD; Dirkje S. Postma, MD, PhD; Karin Vink-Klooster;
COPD: early detection, screening and case-finding: what is the evidence? Prof. Jan-Willem Lammers, Md PhD Department of Respiratory Diseases
COPD: early detection, screening and case-finding: what is the evidence? Prof. Jan-Willem Lammers, Md PhD Department of Respiratory Diseases «If you test one smoker with cough every day You will diagnose
Lung transplantation has become a feasible option. Bronchiolitis Obliterans Syndrome and Additional Costs of Lung Transplantation*
Bronchiolitis Obliterans Syndrome and Additional Costs of Lung Transplantation* Jan W. K. van den Berg, MD, PhD; Petra J. van Enckevort, PhD; Elisabeth M. TenVergert, PhD; Dirkje S. Postma, MD, PhD; Wim
Pulmonary Function Testing: Concepts and Clinical Applications. Potential Conflict Of Interest. Objectives. Rationale: Why Test?
Pulmonary Function Testing: Concepts and Clinical Applications David M Systrom, MD Potential Conflict Of Interest Nothing to disclose pertinent to this presentation BRIGHAM AND WOMEN S HOSPITAL Harvard
Medium-term outcome after lung transplantation is comparable between brain-dead and cardiac-dead donors
http://www.jhltonline.org FEATURED ARTICLES Medium-term outcome after lung transplantation is comparable between brain-dead and cardiac-dead donors Stéphanie I. De Vleeschauwer, DVM, a Shana Wauters, MSc,
Smoking resumption after lung transplantation: need for standardized screening and importance for long-term outcome.
ERJ Express. Published on August 29, 2013 as doi: 10.1183/09031936.00141113 Smoking resumption after lung transplantation: need for standardized screening and importance for long-term outcome. D. Ruttens
A case of a patient with IPF treated with nintedanib. Prof. Kreuter and Prof. Heussel
A case of a patient with IPF treated with nintedanib Prof. Kreuter and Prof. Heussel Case Overview This case describes the history of a patient with IPF who, at the time of diagnosis, had symptoms typical
Update on heterogeneity of COPD, evaluation of COPD severity and exacerbation
Update on heterogeneity of COPD, evaluation of COPD severity and exacerbation Yung-Yang Liu, MD Taipei Veterans General Hospital Aug 29, 2015 G O lobal Initiative for Chronic bstructive L D ung isease
Usual Interstitial pneumonia and Nonspecific Interstitial Pneumonia. Nitra and the Gangs.
Usual Interstitial pneumonia and Nonspecific Interstitial Pneumonia Nitra and the Gangs. บทน ำและบทท ๓, ๑๐, ๑๒, ๑๓, ๑๔, ๑๕, ๑๗ Usual Interstitial Pneumonia (UIP) Most common & basic pathologic pattern
INTERNET-BASED HOME MONITORING OF PULMONARY FUNCTION AFTER LUNG TRANSPLANTATION. 2000, 25 patients underwent heart lung (HLT) or bilateral-lung (BLT)
Online Supplement for: INTERNET-BASED HOME MONITORING OF PULMONARY FUNCTION AFTER LUNG TRANSPLANTATION METHODS Patients Between the start of the study in June 1998 and the end of the study in September
Understanding the mode of action of a drug using Functional Respiratory Imaging (FRI) Roflumilast Study. Jan De Backer, MSc, PhD, MBA CEO
Understanding the mode of action of a drug using Functional Respiratory Imaging (FRI) Roflumilast Study Jan De Backer, MSc, PhD, MBA CEO IPAC RS/UF Orlando Inhalation Conference March 20, 2014 OVERVIEW
Chronic lung allograft dysfunction: evolving practice
REVIEW C URRENT OPINION Chronic lung allograft dysfunction: evolving practice Robin Vos, Stijn E. Verleden, and Geert M. Verleden Purpose of review Chronic lung allograft dysfunction (CLAD) was recently
Small Airways Disease. Respiratory Function In Small Airways And Asthma. Pathophysiologic Changes in the Small Airways of Asthma Patients
Small Airways Disease Respiratory Function In Small Airways And Relevant Questions On Small Airway Involvement In How can small airway disease be defined? What is the link between small airway abnormalities
COPD Bronchiectasis Overlap Syndrome.
COPD Bronchiectasis Overlap Syndrome. John R Hurst 1, J Stuart Elborn 2, and Anthony De Soyza 3 on Behalf of the BRONCH-UK Consortium (D Bilton, J Bradley, JS Brown, J Duckers, F Copeland, A Floto, J Foweraker,
A randomised controlled trial of azithromycin to prevent chronic rejection after lung transplantation
Eur Respir J 2011; 37: 164 172 DOI: 10.1183/09031936.00068310 CopyrightßERS 2011 A randomised controlled trial of azithromycin to prevent chronic rejection after lung transplantation R. Vos*,#, B.M. Vanaudenaerde*,#,
The role of Pulmonary function Testing In Interstitial lung disease in infants. [ ipft in child ]
![The role of Pulmonary function Testing In Interstitial lung disease in infants. [ ipft in child ]](/thumbs/77/74805557.jpg "The role of Pulmonary function Testing In Interstitial lung disease in infants. [ ipft in child ]")
The role of Pulmonary function Testing In Interstitial lung disease in infants [ ipft in child ] Introduction Managing infants with diffuse lung disease (DLD) suspected to have interstitial lung disease
Outline Definition of Terms: Lexicon. Traction Bronchiectasis
HRCT OF IDIOPATHIC INTERSTITIAL PNEUMONIAS Disclosures Genentech, Inc. Speakers Bureau Tadashi Allen, MD University of Minnesota Assistant Professor Diagnostic Radiology 10/29/2016 Outline Definition of
4/17/2010 C ini n ca c l a Ev E a v l a ua u t a ion o n of o ILD U dat a e t e i n I LDs
Update in ILDs Diagnosis 101: Clinical Evaluation April 17, 2010 Jay H. Ryu, MD Mayo Clinic, Rochester MN Clinical Evaluation of ILD Outline General aspects of ILDs Classification of ILDs Clinical evaluation
Living with rare lung disease LYMPHANGIOLEIOMYOMATOSIS (LAM): The Patient Perspective. Gill Hollis, Edinburgh January 2010
Living with rare lung disease LYMPHANGIOLEIOMYOMATOSIS (LAM): The Patient Perspective Gill Hollis, Edinburgh January 2010 LAM Basics Disease of the lungs and lymphatics Affects women Causes progressive
Professor Rob Miller
BHIVA AUTUMN CONFERENCE 2013 Including CHIVA Parallel Sessions Professor Rob Miller University College London Medical School COMPETING INTEREST OF FINANCIAL VALUE > 1,000: Speaker Name Prof Rob Miller
Déjà vu all over again
Disclosures Déjà vu all over again None Jonathan Singer MD MS University of California, San Francisco HPI 49 y/o woman presents for lung transplant evaluation for Hypersensitivity Pneumonitis Exposures:
Wim Wuyts. Treatment of idiopathic interstitial pneumonias. March 12 th Interstitial lung diseases state of the art.
nterstitial ungdiseases euven Department of pneumology Unit for interstitial lung diseases University Hospitals Leuven March 12 th 2015 Interstitial lung diseases state of the art Treatment of idiopathic
LTX. Tuesday, April 10, 2018 Hermes. In LUNG TRANSPLANTATION. Scientific Program Committee. Faculty ISHLT ACADEMY CORE COMPETENCIES
ISHLT ACADEMY In LUNG TRANSPLANTATION Tuesday, April 10, 2018 Hermes 7:55 am 5:45 PM Scientific Program Committee CHAIR: Lorriana Leard, MD, UCSF Medical Center, San Francisco, CA, USA CO-CHAIR: Göran
Life-long asthma and its relationship to COPD. Stephen T Holgate School of Medicine University of Southampton
Life-long asthma and its relationship to COPD Stephen T Holgate School of Medicine University of Southampton Definitions COPD is a preventable and treatable disease with some significant extrapulmonary
L ong term survival after lung transplantation is limited by
799 LUNG TRANSPLANTATION Bronchiolitis obliterans following lung transplantation: early detection using computed tomographic scanning P A de Jong, J D Dodd, H O Coxson, C Storness-Bliss, P D Paré, J R
Pediatric High-Resolution Chest CT
Pediatric High-Resolution Chest CT Alan S. Brody, MD Professor of Radiology and Pediatrics Chief, Thoracic Imaging Cincinnati Children s s Hospital Cincinnati, Ohio, USA Pediatric High-Resolution CT Short
Cell Therapy for Lung Indications Choosing the appropriate IND Enabling Animal Model
Cell Therapy for Lung Indications Choosing the appropriate IND Enabling Animal Model Marlowe Eldridge MD Department of Pediatrics and Biomedical Engineering University of Wisconsin School of Medicine and
Key Points: References: Canadian data from the Canadian Cystic Fibrosis Registry 2015 Annual Report normal
1 2 3 Cystic fibrosis is a rare life-long genetic disease that affects approximately 4,000 people in Canada and about 70,000 worldwide regardless of race or ethnicity but is more common in Caucasians 1,2
Double lung, unlike single lung transplantation might provide a protective effect on mortality and bronchiolitis obliterans syndrome
Fakhro et al. Journal of Cardiothoracic Surgery (2017) 12:100 DOI 10.1186/s13019-017-0666-5 RESEARCH ARTICLE Double lung, unlike single lung transplantation might provide a protective effect on mortality
The role of lung function testing in the assessment of and treatment of: AIRWAYS DISEASE
The role of lung function testing in the assessment of and treatment of: AIRWAYS DISEASE RHYS JEFFERIES ARTP education Learning Objectives Examine the clinical features of airways disease to distinguish
Azithromycin and the Treatment of Lymphocytic Airway Inflammation After Lung Transplantation
American Journal of Transplantation 2014; 14: 2736 2748 Wiley Periodicals Inc. C Copyright 2014 The American Society of Transplantation and the American Society of Transplant Surgeons doi: 10.1111/ajt.12942
COPD. Dr.O.Paknejad Pulmonologist Shariati Hospital TUMS
IN THE NAME OF GOD COPD Dr.O.Paknejad Pulmonologist Shariati Hospital TUMS Definition of COPD* COPD is a preventable and treatable chronic lung disease characterized by airflow limitation that is not fully
Bronchiolar disorders: Current perspective on diagnosis & management. Puneet Malhotra Senior Resident, Dept. of Pulmonary Medicine, PGIMER
Bronchiolar disorders: Current perspective on diagnosis & management Puneet Malhotra Senior Resident, Dept. of Pulmonary Medicine, PGIMER Anatomic considerations Classification Diagnostic approach Specific
Disease spectrum. IPA Invasive pulmonary aspergillosis
Aspergillus & ABPA Disease spectrum IPA Invasive pulmonary aspergillosis ABPA ABPA pathophysiology conidia of Aspergillus trapped in mucous and narrowed airways of asthmatics/cf germinate to form hyphae
HOSPITAL RECORD ABSTRACTION FORM
HOSPITAL RECORD ABSTRACTION FORM ID NUMBER: VERSION: A 10/23/2015 0a. Form Completion Date... / / 0b. Staff Code... 0c. Event ID: 0d. Event Date: / / Instructions: Answers are derived from the medical
Bronchiectasis: An Imaging Approach
Bronchiectasis: An Imaging Approach Travis S Henry, MD Associate Professor of Clinical Radiology Cardiac and Pulmonary Imaging Section University of California, San Francisco Large Middle Small 1 Bronchiectasis
2/14/2015. Non-infectious Pulmonary Complications: Diffuse Alveolar Hemorrhage and Bronchiolitis Obliterans Syndrome. Objectives
Non-infectious Pulmonary Complications: Diffuse Alveolar Hemorrhage and Bronchiolitis Obliterans Syndrome Cheryl Tompkins RN MSN CRNP AOCNP Stem Cell Transplant Service UPMC Cancer Centers Objectives 1.
RESPIRATORY PHYSIOLOGY Pre-Lab Guide
RESPIRATORY PHYSIOLOGY Pre-Lab Guide NOTE: A very useful Study Guide! This Pre-lab guide takes you through the important concepts that where discussed in the lab videos. There will be some conceptual questions
UIP OR NOT UIP PATTERN: THAT IS NOT THE ONLY QUESTION!
UIP OR NOT UIP PATTERN: THAT IS NOT THE ONLY QUESTION! STÉPHANE JOUNEAU 11 JULY 2014 Respiratory Medicine Department, Pontchaillou Hospital, Rennes, France CASE OVERVIEW This case highlights how a usual
APSR RESPIRATORY UPDATES
APSR RESPIRATORY UPDATES Volume 4, Issue 7 Newsletter Date: July 2012 APSR EDUCATION PUBLICATION Inside this issue: Quantitative imaging of airways Small-Airway Obstruction and Emphysema in Chronic Obstructive
A Place For Airway Clearance Therapy In Today s Healthcare Environment
A Place For Airway Clearance Therapy In Today s Healthcare Environment Michigan Society for Respiratory Care 2015 Fall Conference K. James Ehlen, MD October 6, 2015 Objectives Describe patients who will
Nitrofurantoin-Induced Lung Toxicity
Severe Nitrofurantoin-Induced Lung Toxicity Rami Jambeih, M.D. 1, John Flesher, M.D. 1,3, Joe J. Lin, M.D. 2,4 University of Kansas School of Medicine Wichita 1 Department of Internal Medicine 2 Department
Bronchiolitis obliterans syndrome
Curr Respir Care Rep (2012) 1:147 156 DOI 10.1007/s13665-012-0020-2 LUNG TRANSPLANT (MR ZAMORA, SECTION EDITOR) Bronchiolitis obliterans syndrome Keith C. Meyer Published online: 6 July 2012 # Springer
Diseases of the Lung and Respiratory Tract, Part I. William Bligh-Glover M.D. Department of Anatomy, CWRU
Diseases of the Lung and Respiratory Tract, Part I William Bligh-Glover M.D. Department of Anatomy, CWRU Educational objectives: Distinguish the types of atelectasis and their etiologies Distinguish the
Coexistence of confirmed obstruction in spirometry and restriction in body plethysmography, e.g.: COPD + pulmonary fibrosis
Volumes: IRV inspiratory reserve volume Vt tidal volume ERV expiratory reserve volume RV residual volume Marcin Grabicki Department of Pulmonology, Allergology and Respiratory Oncology Poznań University
Nontuberculous Mycobacterial Lung Disease
Non-TB Mycobacterial Disease Jeffrey P. Kanne, MD Nontuberculous Mycobacterial Lung Disease Jeffrey P. Kanne, M.D. Consultant Disclosures Perceptive Informatics Royalties (book author) Amirsys, Inc. Wolters
Basic approach to PFT interpretation. Dr. Giulio Dominelli BSc, MD, FRCPC Kelowna Respiratory and Allergy Clinic
Basic approach to PFT interpretation Dr. Giulio Dominelli BSc, MD, FRCPC Kelowna Respiratory and Allergy Clinic Disclosures Received honorarium from Astra Zeneca for education presentations Tasked Asked
Citation for published version (APA): Ouwens, J. P. (2002). The Groningen lung transplant program: 10 years of experience Groningen: s.n.
University of Groningen The Groningen lung transplant program Ouwens, Jan Paul IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check
Bronchiolitis Obliterans after Allogenic Bone Marrow Transplantation: HRCT Findings
Bronchiolitis Obliterans after Allogenic Bone Marrow Transplantation: HRCT Findings Jung Im Jung, MD 1 Won Sang Jung, MD 1 Seong Tai Hahn, MD 1 Chang Ki Min, MD 2 Chun Choo Kim, MD 2 Seog Hee Park, MD
S P I R O M E T R Y. Objectives. Objectives 2/5/2019
S P I R O M E T R Y Dewey Hahlbohm, PA-C, AE-C Objectives To understand the uses and importance of spirometry testing To perform spirometry testing including reversibility testing To identify normal and
Atopic Pulmonary Disease: Findings on Thoracic Imaging
July 2003 Atopic Pulmonary Disease: Findings on Thoracic Imaging Rebecca G. Breslow Harvard Medical School Year IV Churg-Strauss Syndrome Hypersensitivity Pneumonitis Asthma Atopic Pulmonary Disease Allergic
Imaging Small Airways Diseases: Not Just Air trapping. Eric J. Stern MD University of Washington
Imaging Small Airways Diseases: Not Just Air trapping Eric J. Stern MD University of Washington What we are discussing SAD classification SAD imaging with MDCT emphasis What is a small airway? Airway with
2017 BANFF-SCT Joint Scientific Meeting. BARCELONA March 2017
2017 BANFF-SCT Joint Scientific Meeting BARCELONA 27-31 March 2017 Adriana Zeevi PhD (D) ABHI Professor of Pathology, Surgery and Immunology Director of Histocompatibility Laboratory University of Pittsburgh
PFT Interpretation and Reference Values
PFT Interpretation and Reference Values September 21, 2018 Eric Wong Objectives Understand the components of PFT Interpretation of PFT Clinical Patterns How to choose Reference Values 3 Components Spirometry
Small airways diseases, excluding asthma and COPD: an overview
Eur Respir Rev 2013; 22: 128, 131 147 DOI: 10.1183/09059180.00001313 CopyrightßERS 2013 REVIEW Small airways diseases, excluding asthma and COPD: an overview Pierre-Régis Burgel, Anne Bergeron, Jacques
Azithromycin for treatment of bronchiolitis obliterans syndrome in adult lung transplant recipients(protocol)
Cochrane Database of Systematic Reviews Azithromycin for treatment of bronchiolitis obliterans syndrome in adult lung transplant recipients(protocol) SafaviS,PrayleAP,HallIP,ParmarJ SafaviS,PrayleAP,HallIP,ParmarJ.
Antibody-Mediated Rejection in the Lung Allograft. Gerald J Berry, MD Dept of Pathology Stanford University Stanford, CA 94305
Antibody-Mediated Rejection in the Lung Allograft Gerald J Berry, MD Dept of Pathology Stanford University Stanford, CA 94305 Gerald J Berry, MD Professor of Pathology Stanford University, Stanford, CA
Regional Comparisons of CT Air Trapping and MRI Ventilation Defect Percent in Asthma
Regional Comparisons of CT Air Trapping and MRI Ventilation Defect Percent in Asthma V. A. Zavaletta 1, D.G. Mummy 4, T. Lampkins 4, W. Zha 4, M. L. Schiebler 1, N. Jarjour 3, L. Denlinger 3, and S.B.
Current Approaches to Asthma & COPD
10/11/18 Current Approaches to Asthma & COPD Lekshmi Santhosh, M.D. Assistant Professor, Pulm/Critical Care & Hosp Med Primary Care Medicine: Principles & Practice 10.11.2018 Revisiting the Dutch Hypothesis:
COPD, Asthma, Or Something In Between? Sharon R. Rosenberg Assistant Professor of Medicine Northwestern University December 4, 2013
COPD, Asthma, Or Something In Between? Sharon R. Rosenberg Assistant Professor of Medicine Northwestern University December 4, 2013 None Disclosures Definitions Asthma Asthma is a chronic inflammatory
RADIOLOGIC EVALUATION OF PULMONARY NTM INFECTION. Tilman Koelsch, MD National Jewish Health - Department of Radiology
Pr N op ot e fo rty rr o f ep Pr ro es du en ct te io r n RADIOLOGIC EVALUATION OF PULMONARY NTM INFECTION Tilman Koelsch, MD National Jewish Health - Department of Radiology Disclosures None Goals Identify
Acute and Chronic Lung Disease
KATHOLIEKE UNIVERSITEIT LEUVEN Faculty of Medicine Acute and Chronic Lung Disease W De Wever, JA Verschakelen Department of Radiology, University Hospitals Leuven, Belgium Clinical utility of HRCT To detect
Current diagnostic recommendations for ILD: The multidisciplinary meeting TSANZSRS ASM
Medicine, Nursing and Health Sciences Current diagnostic recommendations for ILD: The multidisciplinary meeting Dr Ian Glaspole Central and Eastern Clinical School, Alfred Hospital and Monash University
Pulmonary manifestations of CTDs Diagnosis, differential diagnosis and treatment
Prague, June 2014 Pulmonary manifestations of CTDs Diagnosis, differential diagnosis and treatment Katerina M. Antoniou, MD, PhD As. Professor in Thoracic Medicine ERS ILD Group Secretary Medical School,
June 2013 Pulmonary Case of the Month: Diagnosis Makes a Difference. Lewis J. Wesselius, MD 1 Henry D. Tazelaar, MD 2
June 2013 Pulmonary Case of the Month: Diagnosis Makes a Difference Lewis J. Wesselius, MD 1 Henry D. Tazelaar, MD 2 Departments of Pulmonary Medicine 1 and Laboratory Medicine and Pathology 2 Mayo Clinic
Parametric response mapping
Parametric response mapping Utility of a novel imaging biomarker in pulmonary disease Dharshan Vummidi MD, Lama VN MD, Yanik G MD, Kazerooni EA MD, Meilan Han MD, Galban C PhD Radiology, Pulmonary & Critical
Eosinophils and effusion: a clinical conundrum
Ruth Sobala, Kevin Conroy, Hilary Tedd, Salem Elarbi kevin.peter.conroy@gmail.com Respiratory Dept, Queen Elizabeth Hospital, Gateshead, UK. Eosinophils and effusion: a clinical conundrum Case report A
Therapeutic options for bronchiolitis obliterans Syndrome after lung transplantation
Zurich Open Repository and Archive University of Zurich Main Library Strickhofstrasse 39 CH-8057 Zurich www.zora.uzh.ch Year: 2016 Therapeutic options for bronchiolitis obliterans Syndrome after lung transplantation
Pathophysiology of COPD 건국대학교의학전문대학원
Pathophysiology of COPD 건국대학교의학전문대학원 내과학교실 유광하 Rate per 100 0,000 population 550 500 450 400 350 300 250 200 150 100 50 0 Heart disease Cancer Stroke 1970 1974 1978 1982 1986 1990 1994 1998 2002 Year of
Overview of Obstructive Diseases of the Lung, Lung Physiology and Imaging Modalities
Overview of Obstructive Diseases of the Lung, Lung Physiology and Imaging Modalities Jann Mortensen Final Phil meeting, 29 april 2004 Obstructive disease Definition Epidemiologi Mechanisms Natural history
NONE OVERVIEW FINANCIAL DISCLOSURES UPDATE ON IDIOPATHIC PULMONARY FIBROSIS/IPF (UIP) FOR PATHOLOGISTS. IPF = Idiopathic UIP Radiologic UIP Path UIP
UPDATE ON IDIOPATHIC PULMONARY FIBROSIS/IPF () FOR PATHOLOGISTS Thomas V. Colby, M.D. Professor of Pathology (Emeritus) Mayo Clinic Arizona FINANCIAL DISCLOSURES NONE OVERVIEW IPF Radiologic Dx Pathologic
Accurate Diagnosis Of Postoperative Pneumonia Requires Objective Data
Accurate Diagnosis Of Postoperative Pneumonia Requires Objective Data David Ebler, MD David Skarupa, MD Andrew J. Kerwin, MD, FACS Jhun de Villa, MD Michael S. Nussbaum, MD, FACS J.J. Tepas III, MD, FACS
7/7/2015. Somboon Chansakulporn, MD. History of variable respiratory symptoms. 1. Documented excessive variability in PFT ( 1 test)
Definition of Asthma GINA 2010: Chronic inflammatory disorder of the airways Airway hyper-responsiveness Recurrent wheezing, breathlessness, chest tightness, coughing Variable, reversible airflow obstruction