Pulmonology News
FDA Finds Pneumonia Risk with Daptomycin
The FDA said that the intravenous antibiotic daptomycin (Cubicin) may be linked to an increased risk of eosinophilic pneumonia -- a rare but serious potential side effect -- and requested that a new drug label warning be added.
The agency reviewed the medical literature and adverse event reports for daptomycin and identified seven cases of eosinophilic pneumonia between 2004 and 2010 "that were most likely associated with Cubicin" on the basis of six criteria, the agency indicated in a Drug Safety Communication.
Femoral-Based Central Venous Oxygen Saturation Is Not a Reliable Substitute for Subclavian/Internal Jugular-Based Central Venous Oxygen Saturation
Central venous oxygen saturation (Scvo2) has been used as a surrogate marker for mixed venous oxygen saturation (Svo2). Femoral venous oxygen saturation (Sfvo2) is sometimes used as a substitute for Scvo2. The purpose of this study is to test the hypothesis that these values can be used interchangeably in a population of patients who are critically ill. This study revealed a significant difference between paired samples of Scvo2 and Sfvo2. More than 50% of Scvo2 and Sfvo2 values diverged by > 5%. Sfvo2 is not always a reliable substitute for Scvo2 and should not routinely be used in protocols to help guide resuscitation.
Adult asthma is associated with low socio-economic status
Low socio-economic status is often related to health problems; however, previous studies on asthma, usually cross-sectional, yield inconsistent results. In this study, longitudinal and cross-sectional data on the association between socio-economic status and asthma as well as respiratory symptoms among adults are presented. It was found that Low socio-economic status is significantly associated with an increased risk for prevalent and incident asthma and respiratory symptoms in this longitudinal population-based survey. The increase in risk was most pronounced in manual workers. Several studies have recently shown an association between low socio-economic status and respiratory symptoms and we conclude that asthma can not be considered as a disease that mainly affects the middle and upper socio-economic classes.
Oral and IV Steroids In COPD Exacerbations Shows No Difference
Systemic corticosteroids are beneficial for patients hospitalized with acute exacerbation of chronic obstructive pulmonary disease (COPD); however, their optimal dose and route of administration are uncertain. This article in this weeks JAMA showed that among patients hospitalized for acute exacerbation of COPD low-dose steroids administered orally are not associated with worse outcomes than high-dose intravenous therapy.
No Difference in Mortality in Patients Ventilated With Synchronized Intermittent Mandatory Ventilation With Pressure Support
Few data are available regarding the benefits of one mode over another for ventilatory support. This article compared clinical outcomes of patients receiving synchronized intermittent mandatory ventilation with pressure support (SIMV-PS) compared with assist-control (A/C) ventilation as their primary mode of ventilatory support through a secondary analysis of an observational study conducted in 349 ICUs from 23 countries. SIMV-PS was less likely to be selected if patients were ventilated because of asthma or coma, or if they developed complications such as sepsis or cardiovascular failure during mechanical ventilation. In the stratified analysis according to propensity score, we did not find significant differences in the in-hospital mortality. After adjustment for propensity score, overall effect of SIMV-PS on in-hospital mortality was not significant
Platelet hyperfunction is decreased by additional aspirin loading in patients presenting with myocardial infarction on daily aspirin therapy
Currently 162-325 mg aspirin is recommended for the treatment of acute coronary syndrome. This article out of the journal Critical Care Medicine tested the effect of an additional loading dose of 250 mg aspirin at the onset of acute coronary syndrome in patients who were already on chronic therapy with 100 mg aspirin. It found that aspirin loading in the emergency room further reduced thromboxane B2 levels and further inhibited platelet function in many patients with acute coronary syndrome already on 100 mg aspirin.
Prognostic Significance of Deep Vein Thrombosis in Patients Presenting with Acute Symptomatic Pulmonary Embolism
Concomitant deep vein thrombosis (DVT) in patients with acute pulmonary embolism (PE) has an uncertain prognostic significance. An article in the American Journal of Respiratory and Critical Care Medicine conducted a prospective cohort study of outpatients diagnosed with a first episode of acute symptomatic PE. Patients underwent bilateral lower extremity venous compression ultrasonography to assess for concomitant DVT.The results showed that In patients with a first episode of acute symptomatic PE, the presence of concomitant DVT is an independent predictor of death in the ensuing 3 months after diagnosis.
Increased Risk of Myocardial Infarction and Stroke Following Exacerbation of COPD
Patients with COPD are at risk for cardiovascular events. This is attributed to increased systemic inflammation. The course of COPD is punctuated by exacerbations, which further increase systemic inflammation, but the risk of vascular events in the postexacerbation period has never been defined. An article in the journal Chest analyzed data from 25,857 patients with COPD entered in The Health Improvement Network database over a 2-year period. Exacerbations were defined using a health-care use definition of prescription of oral corticosteroids > 20 mg/d and/or selected oral antibiotics. There was a 2.27-fold (95% CI, 1.1-4.7; P = .03) increased risk of MI 1 to 5 days after exacerbation (defined by prescription of both steroids and antibiotics). This relative risk diminished progressively with time and was not significantly different from the baseline MI risk at any other postexacerbation time interval. One in 2,513 exacerbations was associated with MI within 1 to 5 days. There was a 1.26-fold (95% CI, 1.0-1.6; P = .05) increased risk of stroke 1 to 49 days after exacerbation.
Silver-Coated Endotracheal Tube Reduces Mortality in Patients With Ventilator-Associated Pneumonia
A silver-coated endotracheal tube (ETT) reduced the incidence of ventilator-associated pneumonia (VAP) compared with an uncoated ETT in the North American Silver-Coated Endotracheal Tube (NASCENT) study. An article in the Journal Chest evaluated the effect of an ETT and risk factors on mortality, we performed a retrospective cohort analysis in patients who developed VAP in the NASCENT study. The silver-coated ETT was associated with reduced mortality in patients with VAP, but not in those without VAP. These findings suggest that a silver-coated ETT was associated with reduced mortality in patients who developed VAP.
Gender differences in COPD expression identified
Results from a study conducted in Latin America show significant gender differences in perception of dyspnea and health status among individuals with and without chronic obstructive pulmonary disease (COPD). Writing in the European Respiratory Journal, María Victorina López Varela (Universidad de la República, Montevideo, Uruguay) and team explain: “There is increasing evidence in selected COPD populations supporting gender differences in the clinical expression of COPD.”
Early vs Late Tracheotomy Doesn't Show Difference for Prevention of Pneumonia in Mechanically Ventilated Adult ICU Patients
Tracheotomy is used to replace endotracheal intubation in patients requiring prolonged ventilation; however, there is considerable variability in the time considered optimal for performing tracheotomy. This is of clinical importance because timing is a key criterion for performing a tracheotomy and patients who receive one require a large amount of health care resources. An article in this weeks JAMA looked at the effectiveness of early tracheotomy (after 6-8 days of laryngeal intubation) compared with late tracheotomy (after 13-15 days of laryngeal intubation) in reducing the incidence of pneumonia and increasing the number of ventilator-free and intensive care unit (ICU)-free days. It found that among mechanically ventilated adult ICU patients, early tracheotomy compared with late tracheotomy did not result in statistically significant improvement in incidence of ventilator-associated pneumonia.
Oral Immunotherapy With Inactivated Nontypeable Haemophilus influenzae Reduces Severity of Acute Exacerbations in Severe COPD
Acute exacerbations of COPD reflect in part an inappropriate host response to abnormal bacterial colonization. Orally administered inactivated nontypeable Haemophilus influenzae (NTHi) can drive a specific T-cell response that by promoting intrabronchial phagocytosis down-regulates bronchus inflammation. An article in the weeks Chest looked at subjects with recurrent exacerbations of COPD were studied in a randomized, multicenter, double-blind, placebo-controlled trial, to test efficacy of an NTHi oral immunotherapeutic (HI-164OV). Exacerbations defined as an increase in volume and purulence of sputum were reduced by 16%, moderate-to-severe exacerbations were reduced by 63%, the proportion with episodes requiring corticosteroid therapy was reduced by 56%, mean duration of episodes was reduced by 37% and prescribed courses of antibiotics were reduced by 56% following therapy. Exacerbations requiring admission into hospital were reduced by 90% (P = .04) in the active group.
Long-acting Beta-Agonists with and without Inhaled Corticosteroids and Catastrophic Asthma Events
It is unclear whether long-acting β-agonists with concomitant inhaled corticosteroids increase asthma-related intubations and deaths. A study from this months American Journal of Medicine pooled data on long-acting β-agonists with variable and concomitant inhaled corticosteroids to evaluate the risk for catastrophic asthma events. In pooled trial data that included 36,588 participants, long-acting β-agonists increased catastrophic events 2-fold (Peto odds ratio [OR] 2.10; 95% confidence interval [CI], 1.37-3.22). Statistically significant increases were seen for long-acting β-agonists with variable corticosteroids compared with placebo (OR 1.83; 95% CI, 1.14-2.95) and for concomitant treatment with corticosteroids compared with corticosteroids alone.
Chest Tube Size Doesn't Affect Outcome in Pleural Infection
The optimal choice of chest tube size for the treatment of pleural infection is unknown, with only small cohort studies reported describing the efficacy and adverse events of different tube sizes. An article published in Chest evaluated a total of 405 patients with pleural infection and showed smaller, guide-wire-inserted chest tubes cause substantially less pain than blunt-dissection-inserted larger tubes, without any impairment in clinical outcome in the treatment of pleural infection.
Biomarker Guideline Reduced Antibiotic Use
A biomarker-guided strategy for antibiotics in intensive care units reduced drug use without increasing mortality, French researchers said.
In a randomized, open-label study, the biomarker procalcitonin allowed physicians to reduce the quantity of antibiotics they prescribed, according to Michel Wolff, MD, of Hôpital Bichat-Claude-Bernard in Paris, and colleagues.
Adding Fish Oil to IV May Speed Sepsis Recovery
Adding fish oil to intravenous solutions proved beneficial for intensive care patients with the potentially lethal blood infection known as sepsis, a new study finds. The study, published Jan. 19 in the journal Critical Care, compared 13 patients who received fish oil in the normal IV nutrient solution given to patients with sepsis, and 10 patients who received traditional solutions. The patients who received the fish oil had lower levels of inflammatory chemicals in their blood, achieved better lung function, and had a shorter hospital stay.
Emphysema Drug Is Safe, FDA Finds
Inhaled tiotropium bromide (Spiriva HandiHaler) for COPD does not pose a special risk for cardiovascular events, the FDA found after reviewing data from a large placebo-controlled trial.
The announcement came nearly two years after the agency said it would investigate the product's safety, after pooled data from earlier trials suggested a 33% increase in stroke risk. (See FDA Cites Excess Strokes with COPD Medicine)
Tiotropium is a long-acting anticholinergic drug that acts as a bronchodilator. It is approved for COPD treatment.
COPD Often Undiagnosed in Two Thirds of Patients
A study on Norwegian adult showed three hundred-three persons (9%) were classified as having COPD, and the undiagnosed fraction was 66%. Spirometry was performed before and after inhalation of 400 µg of salbutamol. COPD was defined as post-bronchodilator forced expiratory volume in 1 s (FEV1) / forced vital capacity (FVC) < 0.7 whereas diagnosed COPD was defined as having received treatment for obstructive lung disease the last year.
Higher Mortality Seen In Patients Admitted to the ICU During Morning Rounds
No previous study has evaluated the association between admission to ICUs during round time and patient outcome. The objective of this study was to determine the association between round-time ICU admission and patient outcome. Although hospital length of stay was no different, the predicted hospital mortality rate of the round time group was higher (17.4% vs 12.3% predicted, respectively; p < 0.001). The hospital length of stay was similar between the two groups. The round-time group had a higher hospital mortality rate (16.2% vs 8.8%, respectively; p < 0.001). Most of the round-time ICU admissions and deaths occurred in the medical ICU and overall round-time admission was an independent risk factor for hospital death.
Survival After Bilateral Versus Single-Lung Transplantation for Idiopathic Pulmonary Fibrosis
Annals of Internal Medicine
Patients with end-stage idiopathic pulmonary fibrosis (IPF) are increasingly having bilateral rather than single-lung transplantation. This study included 3327 patients with IPF who had single (2146 patients [64.5%]) or bilateral (1181 patients [35.5%]) lung transplantation between 1987 and 2009. Overall survival did not differ between patients who had single and bilateral lung transplantation. Single-lung transplantation confers short-term survival benefit but long-term harm, whereas bilateral transplantation confers short-term harm but long-term survival benefit.
Shortness of Breath in Exercise Not Always Asthma
Researchers suggested here that many people who are diagnosed with exercise-induced shortness of breath and asthma frequently may be misdiagnosed. In this study, patients exercised and the combination of symptom assessment, physical examination, and pulmonary function testing was used to make a diagnosis. "We found that of the 785 patients who were being treated for shortness of breath in our clinic, 362 of them -- about 46.2% -- were simply overexerting themselves," said Tim Stewart, a physician assistant at the Colorado Allergy and Asthma Centers in Denver.
Chronic obstructive pulmonary disease as an independent risk factor for cardiovascular morbidity
Recent studies described association between chronic obstructive pulmonary disease (COPD) and increased risk of cardiovascular diseases (CVD). In their analysis none of these studies accounted for sociodemographic factors, health behaviors, and patient comorbidities simultaneously
Low birth weight increases risk for respiratory illness hospitalization in adults
Adults with a history of very low (VL) or moderately low (ML) birth weight (BW) are at increased risk for hospitalization for respiratory illness, show study results.
FDA Investigating Safety of Asthma Drug Xolair
The U.S. Food and Drug Administration has begun a safety review of the asthma drug Xolair (omalizumab) after reports of an increased risk of heart attack, abnormal heart rhythm, heart failure and stroke, the agency said Thursday.
COPD exacerbation: Lost in translation
The introduction and acceptance of a standard definition for exacerbations of COPD can be helpful in prompt diagnosis and management of these events. The latest GOLD executive committee recognised this necessity and it has now included a definition of exacerbation in the guidelines for COPD which is an important step forward in the management of the disease.
Determinants Of Weaning Success In Patients With Prolonged Mechanical Ventilation
Physiological determinants of weaning success and failure are usually studied in ventilator-supported patients comparing those who failed a trial of spontaneous breathing with those who tolerated such a trial and were successfully extubated. A major limitation of these studies was that the two groups may be not comparable concerning the severity of the underlying disease and the presence of comorbidities.
Asthma Drugs Get "Precautionary" Label for Possible Psychiatric Side Effects
The U.S. Food and Drug Administration on Friday requested that the makers of a class of asthma drugs called leukotriene receptor agonists place a "precaution" on the drugs' labeling, warning of the potential for neuropsychiatric events.
Healthier Lifestyle Can Cut COPD Symptoms
A lifestyle intervention program that promoted exercise, healthy eating and quitting smoking improved the health of people with mild to moderate chronic obstructive pulmonary disease (COPD) and was cost-effective, a new study shows
Decreased Serum Vitamin D Levels Increases Severity of Childhood Asthma Respiratory and Critical Care Medicine
In examining the relation between 25-hydroxyvitamin D levels (the major circulating form of vitamin D) and markers of allergy and asthma severity in a cross-sectional study of 616 Costa Rican children between the ages of 6 and 14 years. 28%) had insufficient levels of vitamin D (<30 ng/ml). In multivariate linear regression models, vitamin D levels were significantly and inversely associated with total IgE and eosinophil count.
Pulmonary Embolism Tied to Severe COPD Exacerbations
Pulmonary embolism may cause a quarter of the exacerbations of chronic
obstructive pulmonary disease (COPD) serious enough to warrant hospital
admission, researchers here said.
CHEST Abstract: Prevalence of Pulmonary Embolism in Acute Exacerbations of COPD
People With Sleep Apnea Have More Atherosclerosis
International Journal of
Cardiology
Sleep apnea hypopnea syndrome (SAHS) is a predictive factor of cardiovascular
disease and its hypothesized that SAHS could influence coronary atherosclerosis
plaque volume as assessed by 3-dimensional intravascular ultrasound
(3D-IVUS). In patients with stable coronary artery disease, there was a significant
relationship between the frequency of obstructive sleep apnea/hypopnea episodes
and sleep fragmentation and the importance of coronary atherosclerotic plaque
volume.
