Clinic and Consults Archives - PulmCCM
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Clinic and Consults Articles

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]

Nov 252016
 
Life-sucking power of electronic health records measured, reported, lamented

Feel like you spend twice as much time on your electronic health record as you do with patients? You may be doing better than half of your colleagues. In a new work study funded by the American Medical Association, researchers observed 57 physicians in internal medicine, family medicine, cardiology, and orthopedics over hundreds of hours. They discovered [… read more]

Nov 232016
 
Breo Ellipta beat usual care for COPD in real-world study

GlaxoSmithKline recently got a boost for fluticasone-furoate + vilanterol (Breo Ellipta), its new once-daily COPD maintenance inhaler. Patients with COPD randomized to Breo Ellipta (called Relvar Ellipta in Europe), instead of usual care, had 8% fewer exacerbations and no increased risk for serious adverse events over one year. GSK presented the data at the ERS [… read more]

Jul 172015
 
Recurrent PE risk after long-term warfarin therapy remains high (PADIS-PE)

Not long ago, doctors were taught that 6 months of anticoagulation was plenty for patients with unprovoked pulmonary embolism. That standard was never based on long-term outcomes studies. And as longer-range data started to come in — gulp — it was clear that large numbers of people treated with 6-month warfarin courses after unprovoked PE [… read more]

Bridging anticoagulation for procedures after DVT/PE: usually, more harm than help?

 Clinic and Consults, Interventional Pulmonology, Pulmonary Embolism / DVT / VTE  Comments Off on Bridging anticoagulation for procedures after DVT/PE: usually, more harm than help?
Jul 172015
 
Bridging anticoagulation for procedures after DVT/PE: usually, more harm than help?

“Bridging” anticoagulation — usually, interrupting chronic warfarin therapy, starting injectable or intravenous heparin, stopping just before an invasive procedure, restarting heparin and warfarin after, then stopping heparin — is a cumbersome and common practice in medicine. A new paper in JAMA Internal Medicine suggests that for most patients taking anticoagulation after deep venous thrombosis (DVT) [… read more]

Jul 152015
 
Medicare will pay for death panels, I mean end-of-life counseling

Medicare announced last week it will finally pay doctors for their time spent talking to patients about their end-of-life preferences, among the most important medical decisions most people will make. The decision overcomes years of setbacks brought about by Sarah Palin’s politicizing of the Affordable Care Act’s provision for end-of-life counseling as endorsing “death panels” of [… read more]

May 292015
 
FDA approves once-daily tiotropium with olodaterol (Stiolto)

Image: Stuart Fisher The FDA approved Boehringer Ingelheim’s Stiolto, the latest of the new generation of once-daily inhalers for maintenance treatment of COPD. Stiolto contains the long-acting antimuscarinic agent tiotropium (Spiriva) and the long acting beta agonist olodaterol (marketed separately as Striverdi). Stiolto made it to approval based on 2 separate year-long phase III randomized [… read more]

Apr 192015
 
Do long-acting beta agonists for asthma cause birth defects?

Or, How to Treat Asthma in Pregnancy Do long-acting beta agonists cause birth defects when taken by pregnant women? A new study can’t settle the question, but might give women and their doctors more peace of mind when LABAs are necessary to control asthma during pregnancy. Current guidelines for treating asthma during pregnancy advise that for [… read more]

Mar 202015
 
ProMISe Trial for Sepsis: Usual Care 3, Goal-Directed Therapy 0*

* (since 2014) The ARISE (Australasia) and ProCESS (U.S.) trials, published in 2014, each demonstrated no advantage of protocolized care for sepsis over conscientious usual care. For those remaining unconvinced, the U.K.-based ProMISe trial is available in the New England Journal of Medicine. ProMISe extends the growing global footprint of what some will call the [… read more]

Mar 152015
 
How safe is thoracentesis? Giant case series sheds light

Thoracentesis for pleural effusion — that is, inserting a long needle between someone’s ribs to drain a fluid collection from the chest — has always come with a scary menu of potential risks, including pneumothorax, hemothorax and pulmonary edema. A new study reports a low complication rate from thousands of thoracenteses. But debate will remain whether the safety results — achieved [… read more]

FDA warns: drinking on Chantix may have unexpected effects

 Clinic and Consults, Policy, Ethics, Education  Comments Off on FDA warns: drinking on Chantix may have unexpected effects
Mar 092015
 
FDA warns: drinking on Chantix may have unexpected effects

The U.S. Food and Drug Administration announced today that varenicline (Chantix) can alter people’s reaction when drinking alcohol, potentially causing a lowered tolerance, blackouts, and aggressive behavior. Oh, and watch out for seizures too (these were rare). The warnings come as advance notice of a label change, based on FDA’s review of cases reported over time by Pfizer [… read more]

Jan 102015
 
Cytisine for smoking cessation: as good as nicotine replacement -- and cheap

The smoking cessation drug varenicline (Chantix) works by weakly activating and also blocking nicotine receptors in the brain, simultaneously. This neat trick has the dual effects of reducing tobacco cravings while also blunting the “high” from smoking. That combination has made Chantix the most successful smoking-cessation therapy on the market, but it costs about $500 for [… read more]

Oct 312014
 
Safe to stop inhaled steroids in COPD (and start more expensive drugs)?

Olodaterol People with severe chronic obstructive pulmonary disease (COPD) often have persistent dyspnea or exacerbations despite the use of a single controller inhaler. (Controller inhalers for COPD most often include combination inhaled corticosteroid/long-acting beta agonists like Advair, Dulera and Symbicort [ICS/LABAs] and the long-acting anticholinergic agent Spiriva/tiotropium). These patients often take both a combination ICS/LABA and Spiriva, so-called [… read more]

Aug 162014
 
Which cancer patients need prophylaxis for DVT and pulmonary embolism?

People with cancer have the highest rates of deep venous thrombosis (DVT) and pulmonary embolism (PE). However, the risk of venous thromboembolism varies widely by cancer type and between patients. Daily anticoagulant use can reduce the risk of DVT and pulmonary embolism, but at a cost of increased bleeding risk, patient inconvenience and discomfort, and cost. [… read more]

Jul 082014
 
Using bronchoalveolar lavage to evaluate ILD

Using BAL Cellular Analysis in Interstitial Lung Disease The role of bronchoalveolar lavage (BAL) in diagnosing and managing patients with interstitial lung disease (ILD) has always been uncertain and controversial. BAL findings are usually nonspecific, suggesting rather than proving the existence of any particular noninfectious condition (including interstitial lung disease). That said, in patients with [… read more]

Jun 272014
 
Azithromycin for COPD exacerbations: 2014 Update

Azithromycin to Prevent COPD Exacerbations: What’s New? By Abhishek Biswas, MD Multiple previous studies have suggested likely benefits from using azithromycin as an immunomodulator for cystic fibrosis, bronchiectasis, diffuse panbronchiolitis, post-transplant obliterative bronchiolitis and COPD. This month, a new Cochrane analysis and clinical review in JAMA concludes that “continuous macrolide antibiotic use for prophylaxis [is] associated with a [… read more]

Jun 082014
 
PulmCCM Roundup #4

All the best in pulmonary and critical care from around the web. Browse all the PulmCCM Roundups. Asthma Childhood obesity increases the risk for asthma, and obesity is also strongly associated with asthma in adults. The mechanisms are likely multiple, complex and interdependent (pro-inflammatory mediators, etc.), not simply causative. Losing weight does seem to improve [… read more]

May 072014
 
FDA approves implantable tongue-buzzer for obstructive sleep apnea treatment

Image: Inspire Med Systems Hypoglossal Nerve Stimulation for Sleep Apnea Wins FDA Approval The U.S. Food and Drug Administration approved Inspire Medical Systems’ pacemaker-like hypoglossal nerve stimulator for patients with moderate to severe obstructive sleep apnea (OSA) who cannot tolerate continuous positive airway pressure (CPAP). The Inspire device stimulates key airway muscles controlled by the hypoglossal [… read more]

May 032014
 
N-acetylcysteine for COPD: another trial shows benefit (PANTHEON)

Image: pipingrock.com Can N-acetylcysteine help prevent exacerbations of chronic obstructive pulmonary disease (COPD)? Another randomized trial says yes. N-acetylcysteine, or NAC, is a nutritional supplement with antioxidant and anti-inflammatory properties. After ingestion, N-acetylcysteine is metabolized into glutathione, a key antioxidant with effects throughout the body. In the lungs, glutathione deficiency (common in alcoholics) is linked [… read more]

Apr 032014
 
PulmCCM Roundup, Issue #2

PulmCCM Roundup #2 Welcome back to the PulmCCM Roundup, formerly the Critical Care Roundup. Let’s jump right in to issue #2. Browse all the PulmCCM Roundups here. Etomidate for intubation in sepsis: what’s the risk, really?  Etomidate has been suspected of causing adrenal insufficiency and potentially death in patients with severe sepsis, when used as an anesthesia-induction agent [… read more]