Steven A SahnMD
Professor of Medicine and Director Division of Pulmonary, Critical Care, Allergy and Sleep Medicine Medical University of South Carolina
Charleston, South Carolina, USA
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Clinical Focus Series
Acute Exacerbation of Respiratory Diseases / Steven A Sahn
First Edition: 2012
9789350252673
Printed in India
567CONTRIBUTING AUTHORS
- Sonia Bains md
- Assistant Professor of Medicine
- Division of Pulmonary, Critical Care,
- Allergy and Sleep Medicine
- Medical University of South Carolina
- Charleston, South Carolina, USA
- Patrick A Flume md
- Professor of Medicine
- Director of the Cystic Fibrosis Center
- Division of Pulmonary, Critical Care,
- Allergy and Sleep Medicine
- Medical University of South Carolina
- Charleston, South Carolina, USA
- J Terril Huggins md
- Assistant Professor of Medicine
- Division of Pulmonary, Critical Care,
- Allergy and Sleep Medicine
- Medical University of South Carolina
- Charleston, South Carolina, USA
- Marc A Judson md
- Professor of Medicine and Chief
- Division of Pulmonary and Critical Care
- Medicine, Department of Medicine
- Albany Medical College
- Albany, New York, USA
- Lawrence Mohr md
- Professor of Medicine
- Environmental Biosciences Program and Department of Medicine
- Medicine, Department of Medicine
- Charleston, South Carolina, USA
- Efstratios Panselinas md
- Pulmonary Department
- General Army Hospital
- Tripoli, Greece
- Vlassis Polychronopoulos md
- Director, Third Chest Department
- Sismanoglion Hospital
- Athens, Greece
- Steven A Sahn md
- Professor of Medicine and Director
- Division of Pulmonary, Critical Care,
- Allergy and Sleep Medicine
- Medical University of South Carolina
- Charleston, South Carolina, USA
- Charlie Strange md
- Professor of Medicine
- Division of Pulmonary, Critical Care,
- Allergy and Sleep Medicine
- Medical University of South Carolina
- Charleston, South Carolina, USA
- Timothy PM Whelan md
- Associate Professor of Medicine
- Medical Director of Adult Lung
- Transplantation Program
- Medical University of South Carolina
- Charleston, South Carolina, USA
The medical dictionary defines “acute” as referring to a health effect that is brief and not chronic, and sometimes, loosely used to mean severe. In referring to exposure, it may be brief, intense, short-term, or of high intensity. An exacerbation is defined as an increase in the severity of a disease that may have its onset rapidly over one or two hour time-frame as in asthma, over a few days as in COPD, or more insidious over several days or weeks, as in cystic fibrosis and non-cystic fibrosis bronchiectasis. These exacerbations may be more insidious, as in IPF and sarcoidosis. Drug-induced adverse effects can be observed over a spectrum from an acute hypersensitivity reaction, or more commonly, an insidious change in the respiratory status that can vary in intensity and duration of exposure. In IPF, the typical time of the “acute exacerbation” varies from one to four weeks and results in significant mortality. A pulmonary exacerbation of sarcoidosis needs to be differentiated from other respiratory illnesses, as their treatments would be different. Classification of hypersensitivity pneumonitis (HP) into acute, subacute, and chronic forms can be misleading, as the clinical findings often overlap in a particular individual. Acute HP, in a previously undiagnosed individual typically begins relatively soon after exposure within hours with respiratory and constitutional symptoms; while a subacute or chronic exacerbation tends to be more insidious. As the number of lung transplants continues to increase, clinicians will have to address the significant number of medical and surgical issues that impact the patient's survival. Today, as compared to 20 years ago, clinicians now have a number of tools to manage diverse problems, such as acute and chronic rejection. Hopefully, in the not too distant future, there will be an ideal immunosuppressive agent that will prevent rejection and not lead to severe, often fatal infection.
As you read through this book, you will become aware of differences and similarities between an onset and severity of acute exacerbations in different diseases. I hope that this information will enable clinicians to recognize and appropriately manage patients with acute exacerbations of a respiratory disease.
Steven A Sahn