CHEST Guidelines-Serum-Procalcitonin-and-Infective-Exacerbations-of

Serum-Procalcitonin-and-Infective-Exacerbations-of

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The correspondence to the editor of CHEST discusses the ongoing debate about the role of antibiotics and biomarkers in managing asthma and COPD exacerbations, specifically the potential use of procalcitonin as a marker for guiding antibiotic therapy. Current guidelines do not recommend antibiotics for asthma exacerbations often associated with viral infections, with Dr. D’silva's findings identifying viruses in 36% and bacteria in 24% of cases. The letter points out that procalcitonin is not a strong marker for exacerbations but is useful in pneumonia cases. It calls for controlled trials to explore biomarker-guided therapy, common in cardiology, to be more deeply investigated in respiratory medicine.<br /><br />The second section addresses the use of MRI in diagnosing acute pulmonary embolism (APE), highlighting advancements in MRI technology, which improve its utility and reduce the limitations that previously restricted its clinical acceptance. Enhancements such as parallel imaging have improved MRI’s spatial resolution and reduced motion artifacts. Compared with standard methods like MDCT scans, MRI offers benefits like no radiation exposure. However, despite promising results and a high specificity reported in some studies, concerns exist regarding its reliability, as noted in the PIOPED III study, which recognized the limitations of MRI in detecting pulmonary embolism due to technical inadequacies in certain cases. Therefore, MRI is recommended only in specialized centers for patients unable to undergo standard tests.<br /><br />Overall, the letters discuss the need for further research and validation of new methods and biomarkers in managing respiratory illnesses and the potential for MRI as a valuable diagnostic tool under specific circumstances.

Keywords

antibiotics

biomarkers

asthma

COPD

procalcitonin

MRI

pulmonary embolism

respiratory medicine

pneumonia

diagnostic tools