CPAP Improves Metabolic Syndrome in Obstructive Sleep Apnea Continuous positive airway pressure (CPAP) therapy reversed elements of the high cardiovascular risk profile known as metabolic syndrome in a substantial minority of Indians with treatment-naive obstructive sleep apnea, according to this article in the New England Journal of Medicine. More than 75% of people with obstructive [... read more]
Adding Spiriva to LABA and Inhaled Steroid Might Improve COPD No strong outcomes-based evidence exists as to the benefits in treating chronic obstructive pulmonary disease (COPD) with tiotropium, long-acting beta-agonist and inhaled corticosteroid together — so called “triple therapy.” LABA and tiotropium together do provide additive bronchodilation over either agent alone, evidence suggests. However, only [... read more]
Is In-Flight Oxygen for Pulmonary Hypertension Necessary? After finding a high rate of symptoms among people with pulmonary hypertension during commercial air flights, Nareg Roubinian, C. Gregory Elliott, and Hubert Chen are recommending that everyone with significant pulmonary hypertension planning to take a flight longer than 2.5 hours should be evaluated for supplemental in-flight oxygen. [... read more]
Extra Vitamin D Doesn’t Prevent Colds in Healthy Adults (JAMA) It looks like you can add Vitamin D to list of supplements (echinacea, vitamin C, etc.) who’ve gone up against the common cold and lost. (Scorekeepers will note that zinc held its own, though, in a Cochrane analysis.) Vitamin D plays an important role in immune responses, [... read more]
Most people with mild to moderate obstructive sleep apnea (OSA with AHI of 5 to 30) have no bothersome daytime symptoms. In fact, less than a third (28%) experience daytime sleepiness that impairs their daily functioning (Epworth score > 10). No one had ever shown whether treatment with continuous positive airway pressure (CPAP) improves daytime [... read more]
Like many other bodily functions, coughing is a complex phenomenon that is under both conscious and unconscious control. Coughing during an acute bronchitis or after inhaling a lungful of seawater is vigorous and involuntary. A slight tickle in the back of the throat that creeps up when we’re on a first date or in a [... read more]
Caring For Older Folks With COPD Terri Fried, Carlos Fragoso, and Michael Rabow argue in the September 26, 2012 JAMA that older adults (age ~80 or above) with COPD and significant dyspnea are a distinct, complex group of patients with unique features and needs, and their doctors should think broadly and be willing to go [... read more]
Chronic cough is the scourge both of the coughers themselves, and the doctors who treat them. Although rarely medically serious, chronic cough can be surprisingly debilitating by disrupting sufferers’ social and professional lives — church, piano recitals, and business meetings are a few situations that involuntary coughing can mess with your mojo. Doctors, for their [... read more]
(image: DiagnosticClinic.com) Exacerbations of chronic obstructive pulmonary disease (COPD exacerbations) occur with wide variability in people with COPD, and no one really knows why. Respiratory infections, interactions with coexistent cardiovascular disease, and pulmonary embolism have all been implicated as causes of exacerbations. But some people with COPD experience exacerbations that are mild and infrequent, while [... read more]
The FDA announced earlier this month that it granted approval to 10 generic manufacturers to produce and market generic forms of montelukast, sold by Merck since its approval in 1998 as Singulair. Brand-name Singulair currently costs about $168 per month, so cost competition could bring considerable savings to those taking the medication (and their insurance [... read more]
Obstructive sleep apnea (OSA) might be the perfect disease to describe the American health care system. The condition is overwhelmingly due to our over-indulgence and under-activity; its expensive diagnosis (polysomnography) and best treatment (CPAP) help physicians and device manufacturers prosper while consternating those who pay (the government and insurance companies), who then threaten to cut off [... read more]
Advances in Diagnosis and Treatment of Non-Small Cell Lung Cancer (NSCLC) This review document is periodically updated and reposted as new information is published. Please comment below with your suggestions for inclusion in upcoming updates of this review. (More PulmCCM topic reviews) The diagnosis and treatment of non-small cell lung cancer (NSCLC) is rapidly evolving, [... read more]
Alpha-1 Antitrypsin Deficiency: 2012 Review & Update More 2012 Topic Updates This alpha-1 antitrypsin review is periodically updated and reposted as new research findings are published. Alpha-1 antitrypsin deficiency is underrecognized and by implication undertreated, according to James Stoller and Loutfi Aboussouan of the Cleveland Clinic in their excellent concise clinical review in the Blue [... read more]
We may see it more often, but we doctors don’t really know anything more about death than anyone else, and we find it just as scary. Yet we are expected to spontaneously discuss death-as-a-coming-event with seriously ill patients who (we assume) probably want to avoid the subject, well, like the plague. Maybe they do. But [... read more]
Chronic obstructive pulmonary disease (COPD) was always believed to be a disease of progressive accelerated decline in lung function, even after quitting smoking. However, as it turns out, that time-honored (and still-taught) paradigm, based on some unsure assumptions and weak primary data, is not true. More recent investigations incorporating robust data sets from large populations [... read more]
Acupuncture has danced on the fringes of mainstream Western medical therapy for decades. Acupuncture has been shown to improve numerous conditions –for example, reducing dyspnea in patients with cancer, asthma and chronic obstructive pulmonary disease (COPD) in a few randomized trials. But — unsurprisingly, given complementary medicine’s lack of funding and acceptance among traditional academics — [... read more]
Most studies on smoking and its well-known health risks have been performed in middle-aged adults (younger than 60). In a large epidemiological study published in the June 11, 2012 Archives of Internal Medicine, Carolin Gellert, Ben Schottker, and Hermann Brenner showed that (spoiler alert!!) smoking’s excess risks extend to older adults, as well. Just as importantly, [... read more]
Remember that weird advice we were taught as physicians-in-training to give to smoking patients before an upcoming surgery? “You should quit smoking, but not within the 2 weeks just before your surgery.” (It sounds off-key to me even as I write it now.) Based on … what? Some medical lore passed down from a decades-old study [... read more]
Chronic diseases like chronic obstructive pulmonary disease (COPD) account for at least 2/3 of medical care spending in the U.S. Policy makers, payers, and many physicians recognize that the outpatient clinic-based model is poorly suited to provide support in between physician visits, when most complications or exacerbations occur. Many hospitalizations and decline in function could [... read more]
(image: GE) Exhaled Nitric Oxide Analysis for Respiratory Disease: ATS Guideline A blue ribbon panel led by Raed Dweik releases this ATS practice guideline, recommending when & how to use exhaled nitric oxide (FE-NO) for use in diagnosing and treating inflammatory respiratory conditions. FE-NO’s uses, they say, include: Predicting responsiveness to corticosteroid therapy Helping diagnose [... read more]