Nonpharmacological Therapies in COPD.

Chronic obstructive pulmonary disease has recently been gaining more attention, as beyond impacting roughly 10% of the world's population, it also carries high morbidity and mortality. The mainstay of management is optimizing pharmacological therapy, but various nonpharmacological therapies have shown benefits in providing symptom improvement and relief, prevention and mitigation of exacerbations, quality of life, and even mortality rate. Such modalities include supplemental oxygen therapy, pulmonary rehabilitation, viral and bacterial vaccinations, and noninvasive positive pressure ventilation therapy.

COVID-19: An Update on the Epidemiological, Clinical, Preventive, and Therapeutic Management of 2019 Novel Coronavirus Disease.

The COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2) remains a serious issue for global health, given widespread infectivity and a high contagion rate. A tremendous amount of data has been generated since it was first identified in December 2019. It is vital to keep up with these data from across the world at a time of uncertainty and continuously evolving guidelines and clinical practice. This review provides an update on recent developments concerning epidemiology, clinical presentation, treatment options, and scientific advancements to combat the COVID-19 pandemic.

Chronic Obstructive Pulmonary Disease: Diagnosis and GOLD Classification.

This article describes the various steps required to confirm the diagnosis of chronic obstructive pulmonary disease (COPD). The GOLD Criteria developed by the Global Initiative for COPD will be outlined as they relate to the diagnosis and management of COPD. Pulmonary function testing, imaging, and symptom assessment will be explored.

Institutional COVID-19 Protocols: Focused on Preparation, Safety, and Care Consolidation.

As the confirmed cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue to grow with over 1 million documented infections in the United States alone, researchers and health care workers race to find effective treatment options for this potentially fatal disease. Mortality remains high in patients whose disease course requires mechanical ventilation and admission to intensive care units. While focusing on therapies to decrease mortality is essential, we must also consider the logistical hurdles faced with regard to safely and effectively delivering treatment while limiting the risk of harm to hospital staff and other noninfected patients. In this article, we discuss aspects of surge planning, considerations in limiting health care worker exposure, the logistics of medication delivery in a uniform and consolidated manner, protocols for delivering emergent care in a rapidly deteriorating coronavirus disease-2019 (COVID-19) patient, and safe practices for transporting infected patients.

Acute Respiratory Distress Syndrome Definition, Causes, and Pathophysiology.

First successfully described in 1967, acute respiratory distress syndrome has since garnered much interest and debate. Extensive studies and clinical trials have been carried out in efforts to address the associated high mortality; however, it remains a significant burden on health care. Despite the heterogeneous etiologies that lead to the development of acute respiratory distress syndrome, this rapidly progressing form of respiratory failure, characterized by severe hypoxemia and nonhydrostatic pulmonary edema, has a recognizable pattern of lung injury. In this chapter, we will review the clinical manifestations, definitions, causes, and a brief overview of the pathophysiology of this complex syndrome.

Acute Respiratory Distress Syndrome Novel Therapies.

Acute respiratory distress syndrome (ARDS) was first described in 1967. Since then, several landmark studies have been published that have greatly influenced the way we diagnose and treat patients with ARDS. Despite extensive research and advancements in ventilator strategies, moderate-severe ARDS has been associated with high mortality rates. Current treatment remains primarily supportive with lung-protective ventilation strategies. Pharmacological therapies that reduce the severity of lung injury in vivo and in vitro have not yet translated into effective clinical treatment options. Currently, the mortality rate of severe ARDS remains in the range of 30% to 40%. To review, the mainstay of ARDS management includes mechanical ventilation with low tidal volumes to decrease barotrauma, prone ventilation, conservative fluid management, and neuromuscular blockade. ARDS survivors tend to have long-term and potentially permanent neuromuscular, cognitive, and psychological symptoms, affecting patient's quality of life posthospitalization. These long-term effects are likely secondary to prolonged hospitalizations, prolonged mechanical ventilation, utilization of prone strategies, utilization of paralytic drugs, and occasionally steroids. Therefore, several novel therapies outside the realm of advanced ventilation and prone positioning methods are being studied. In this article, we discuss a few of these novel therapies including prophylactic aspirin, inhaled nitric oxide, mesenchymal stem cells, and intravenous ß-agonists. Steroids and extracorporeal membrane oxygenation have been discussed in a previous article.

Guillain-Barré Syndrome associated with SARS-CoV-2 infection.

We present a case of Guillain- Barré Syndrome (GBS) in a patient with confirmed COVID-19 infection. GBS in commonly encountered after an antecedent trigger, most commonly an infection. To date, only one case of GBS associated with this infection has been described. Clinicians should consider this entity since it may warrant appropriate isolation precautions especially in a patient who may not present primarily with typical constitutional and respiratory symptoms associated with COVID-19.