Pulmonology News
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.
