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Update in Pulmonary Medicine
- 1998-99 Series; John Roberts, MD, Editor From San Francisco General Hospital, San Francisco, California. Requests for Reprints: Talmadge E. King Jr., MD, Department of Medicine, San Francisco General Hospital, 1001 Potrero Avenue, Room 5H22, San Francisco, CA 94110. Current Author Addresses: Dr. King: Department of Medicine, San Francisco General Hospital, 1001 Potrero Avenue, Room 5H22, San Francisco, CA 94110.
Pulmonary medicine involves many diseases that overlap with those of other subspecialties. In this report, I focus on important recent developments in three areas: community-acquired pneumonia, organizing pneumonia, and interstitial lung diseases. Other Updates in this series have addressed emerging issues in pulmonary medicine, including thromboembolic diseases, other infections, respiratory diseases in elderly persons, and asthma [1-3].
Community-Acquired Pneumonia
Pneumonia remains one of the “captains of death,” as Sir William Osler once called it. It is the leading cause of death from infection and is the sixth leading cause of death overall. In the United States, 4 million adults-1.5% of the population-develop community-acquired pneumonia each year. About 1% of all visits to internists are for pneumonia. The total economic burden is estimated to be about $5 billion a year. About 80% of patients are treated as outpatients, at a cost of about $1 billion; 10% of that cost is for antibiotics. In addition, more than 600 000 persons are hospitalized for pneumonia each year.
Low-Risk Patients with Pneumonia Were Identified by Using Simple Assessment
Fine MJ, Auble TE, Yealy DM, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997; 336:243-50.
One of the most important questions facing physicians is, When should a patient with pneumonia be admitted to the hospital? Admission rates vary markedly from one geographic region to the next. Because physicians are often uncertain of the severity of illness, a subjective impression is commonly used to decide whether to hospitalize the patient or send him or her home with a prescription for oral antibiotics. Physicians tend to overestimate the risk for death from acute community-acquired pneumonia, so hospitalization rates are probably higher than necessary.
Fine and colleagues sought to develop a prediction rule to identify patients with pneumonia who are at low risk for death and therefore do not need hospitalization. …
