Pulmonary Central

Pulmonary Central was the previous name for the PulmCCM blog. The PulmCCM team writes the posts under this moniker. Read the About page for more of the PulmCCM story.

Mar 232017
 
Fish oil in pregnancy prevented asthma in kids at age 5

Can fish oil supplements taken during pregnancy prevent asthma in children? According to a randomized trial in the New England Journal of Medicine, yes. Children of 736 pregnant women who took supplements containing given n-3 long-chain polyunsaturated fatty acid during their third trimester had a 31% relative reduction in risk of developing asthma or persistent [… read more]

Mar 172017
 
One third of people with "asthma" may be overdiagnosed (and overtreated)

Anyone caring for patients in a clinic setting knows that asthma can easily be overdiagnosed. Asthma lacks a gold standard test for diagnosis, can produce vague symptoms, and inexpensive, low risk treatments are available (inhaled corticosteroids and albuterol). The result is many dyspneic or coughing patients are given an asthma diagnosis that is provisional or tentative — whether [… read more]

Mar 152017
 
Should FDA mandate lower nicotine content in cigarettes?

In June 2009, then-President Barack Obama signed into law the Family Smoking Prevention and Tobacco Control Act, authorizing FDA to regulate the nicotine content of cigarettes. The only real limit to FDA’s new authority was a provision prohibiting FDA from “requiring the reduction of nicotine yields of a tobacco product to zero.” Prior to that [… read more]

Mar 102017
 
New cryobiopsy for ILD could displace surgical lung biopsy

The various forms of interstitial lung disease (ILD) can be impossible to tell apart without a biopsy. There’s too much overlap between them in their appearance on imaging (high-resolution chest CT), and in clinical features. A surgical lung biopsy is the standard in such cases. For many patients and physicians, though, the risk and discomfort [… read more]

Mar 092017
 
LABA safety studies for asthma saw no increased risk in Advair or Symbicort

After the Serevent Nationwide Surveillance (SNS) and SMART trials both appeared to link the use of long-acting beta agonists (LABAs) to an increased risk of asthma-related death, routine asthma care got scary. The FDA slapped a black box warning on LABAs like Serevent (salmeterol) and Foradil (formoterol) and also the combination treatments containing them (Advair, [… read more]

Mar 082017
 
Pulmonologist incomes down in 2016; self-employed make more

The 2016 Medscape Physician Compensation Report relates that orthopedic surgeons and cardiologists earn on average the most of those physicians surveyed ($443,000 and $410,000 annually) (1). Pulmonologists and critical care physicians fell in the middle of the spectrum of physician incomes ($281,000 and $306,000 respectively). Allergists were at the lower end ($205,000). Physicians in each category earned [… read more]

Mar 022017
 
Therapeutic hypothermia? No benefit in cooling kids after in-hospital cardiac arrest (THAPCA)

Cooling kids to 33ºC after resuscitation from in-hospital cardiac arrest brought no benefits compared to fever prevention (maintenance at 36.8°C), in the large THAPCA randomized trial. After one year, survival was 39% with hypothermia and 36% with management of body temperature in the normal range. There were no differences in neurologic outcomes or any other [… read more]

Mar 012017
 
Are ventilator-associated pneumonia rates plummeting, or unchanged?

In 2008 hospitals were informed they would no longer be paid for treating hospital acquired infections like ventilator associated pneumonia. Miraculously, the rates of VAP (self-reported by hospitals to the Centers for Disease Control and Prevention) fell dramatically by 60 to 70% between 2006 and 2012, to less than one VAP per 1,000 ventilator days [… read more]

Feb 262017
 
PulmCCM Partners With MedPage Today

Dear colleagues, Since 2012, PulmCCM has sought to bring you “all the best in pulmonary and critical care”: up-to-date, useful information in our specialties, presented in the most efficient way. To that end, I am pleased to announce a new partnership between PulmCCM and MedPage Today, the leading medical news service for health-care professionals. This relationship will [… read more]

Feb 222017
 
Simple qSOFA score predicts sepsis as well as anything else

Sepsis is sneaky. Physicians, nurses, and epidemiologists struggle to accurately identify patients with sepsis in the emergency department, hospital ward, and in data sets. The so-called SIRS criteria were abandoned as insensitive and nonspecific in the most recent iteration of sepsis care. Sepsis is instead now defined as “life-threatening organ dysfunction caused by a dysregulated [… read more]

Feb 152017
 
Oxygen saturation in critical illness: could low-normal be best?

Oxygen is essential for life, but by forming superoxides and free radicals, supplemental oxygen can also inflict damage on lung and other body tissues. The sweet spot for oxygen delivery in critically ill patients is unknown, but increasing evidence suggests that when it comes to blood oxygen saturation during critical illness, “normal” levels might actually [… read more]

Feb 092017
 
Reslizumab (CINQAIR) worked as add-on treatment for severe asthma with eosinophilia

Reslizumab (CINQAIR) is a humanized, anti-IL-5 biologic agent approved by FDA in March 2016 as add-on treatment for asthma with peripheral blood eosinophilia, uncontrolled by usual treatments. In two randomized trials, reslizumab improved lung function and asthma symptoms in patients meeting these criteria. Patients without high eosinophil count in peripheral blood did not experience clinically [… read more]

Feb 082017
 
Early renal replacement therapy in critical illness did not improve outcomes (AKIKI)

When is the optimal time to initiate renal-replacement therapy in the ICU? Patients with acute renal failure (a.k.a. acute kidney injury or AKI) in the ICU experience worse outcomes than patients who do not. As the kidneys shut down, toxic electrolytes and metabolic waste products build up in the blood. Intuition says — screams, really [… read more]

Feb 012017
 
Passive leg raise test: helpful maneuver, or ICU parlor trick?

Patients who arrive at the hospital with hypotension will almost all receive intravenous fluid resuscitation (one hopes). When signs of hypoperfusion occur later in a patient’s hospital course, it can be much harder to decide if additional fluid will be helpful. Physical exam is unreliable, and no available technology can accurately identify how much water is [… read more]

Feb 012017
 
Advanced Critical Care Simulation Conference: Feb 17-18 in Phoenix (Register)

Register Now! PulmCCM is not affiliated with Banner University or the University of Arizona. SHARPEN YOUR LIFE-SAVING CRITICAL-CARE SKILLS Focusing on the clinical situations of highest concern to bedside intensivists, including the emergency evaluation of the patient with undifferentiated shock, the failed airway, refractory ARDS and obstetrical code arrest, this conference will bring participants up-to-date [… read more]

Jan 282017
 
Last chance to apply for the ALiEM Faculty Incubator

Junior faculty members: Looking for a way to bolster your academic credentials and engage/network with an established community of medical educators? The ALiEM (Academic Life in Emergency Medicine) Faculty Incubator is a yearlong online faculty development program (limited to 30 participants yearly), nearly exclusively done with online asynchronous interactions through the Slack platform. The incubator [… read more]

Jan 182017
 
Azithromycin was no help in asthma exacerbations (AZALEA)

Adding azithromycin to usual treatment for asthma exacerbations in adults did not improve asthma symptoms or speed their resolution, investigators reported in the AZALEA randomized clinical trial. Patients getting azithromycin also had no improvement in lung function. Azithromycin is known to have some activity against viruses that infect bronchial cells; viruses are causative or contributory [… read more]

Dec 162016
 
Inferior vena cava filters are overused. What's the harm?

Inferior vena cava filters (IVCF) are placed to prevent deep venous thromboses (DVT) from traveling to the heart and lungs, causing pulmonary embolism (PE). IVC filters’ rationale makes sense, but despite their wide use, the benefits and risks of IVCF remain unclear. With about 50,000 IVC filters placed annually in the U.S., that’s a lot of unclarity. [… read more]

Dec 072016
 
New 2017 GOLD Guidelines for COPD Released

The Global Initiative for Obstructive Lung Disease (GOLD – because GIOLD sounded weird) is an international collaboration of experts in chronic obstructive pulmonary disease (COPD). Every so often the GOLD gang releases another update of their standard-setting GOLD guidelines. (Read PulmCCM’s 2014 GOLD guideline review and our COPD Review.) Get the full 2017 GOLD guidelines or the 36 page [… read more]