Berlin Definition of the Acute Respiratory Distress Syndrome (ARDS)

The Berlin definition, proposed in 2012, breaks with tradition by establishing three risk strata that are based on the degree of hypoxemia as assessed at a minimum positive end-expiratory pressure (PEEP).
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Tumor, Node, Metastasis International Staging System for Lung Cancer

The Tumor, Node, Metastasis (TNM) staging system for lung cancer is an internationally accepted system used to characterize the extent of disease. The TNM system combines features of the tumor into disease stage groups that correlate with survival and are linked to recommendations for treatment.
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ATS/ERS Criteria for Diagnosis of Idiopathic Pulmonary Fibrosis (IPF) in Absence of Surgical Lung Biopsy

Major Criteria

  1. Exclusion of other known causes of ILD such as certain drug toxicities, environmental exposures, and connective tissue diseases

  2. Abnormal pulmonary function studies that include evidence of restriction (reduced VC, often with an increased FEV1/FVC ratio) and impaired gas exchange [increased P(A–a)O2, decreased PaO2 with rest or exercise or decreased DLCO]

  3. Bibasilar reticular abnormalities with minimal ground glass opacities on HRCT scans

  4. Transbronchial lung biopsy or BAL showing no features to support an alternative diagnosis

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GOLD Staging System for Chronic Obstructive Lung Disease (COPD) Severity

The European Respiratory Society (ERS) diagnostic criteria for COPD include the following symptoms: coughing, sputum production and/or dyspnoea, as well as a history of exposure to risk factors for COPD. The diagnosis is confirmed by a post-bronchodilator FEV1/FVC < 0.7 in spirometry, as sign of the airflow limitation that is not fully reversible.

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Indications for Lung Biopsy

Patients with lesions on the chest radiograph should be discussed in a multidisciplinary meeting with a respiratory physician and radiologist at a minimum.

Percutaneous transthoracic lung biopsy (PTLB) should be considered in the following:

  • New or enlarging solitary nodule or mass on the chest radiograph which is not amenable to diagnosis by bronchoscopy or CT shows it is unlikely to be accessible by bronchoscopy.
  • Multiple nodules in a patient not known to have malignancy or who has had a prolonged remission or more than one primary malignancy.
  • Persistent focal infiltrates, either single or multiple, for which no diagnosis has been made by sputum or blood culture, serology, or bronchoscopy.
  • Hilar mass following negative bronchoscopy. Continue reading