Hartwig et al report a series of 157 people receiving fundoplication within 1 year after lung transplant, for reflux diagnosed by abnormal esophageal pH probe. They compared these to 65 with reflux who did not undergo fundoplication. The surgical patients had about 10% higher FEV1s, both at peak and at one year. This was not [... read more]
Darling et al report findings from the Early Lung PET trial for non-small cell lung cancer. PET-CT had 70% sensitivity and 94% specificity for identifying cancerous mediastinal lymph nodes (with invasive staging as the reference standard). Sounds good. However, among the 22 patients with PET-CT scans positive for mediastinal nodes, 8 did not have cancer [... read more]
Low physical activity is associated with mortality in COPD, but until now, only on the basis of self-reported activity levels. Waschki et al prospectively followed 170 people (~75% men, ~65 years old) with stable COPD for 48 months. Besides spirometry (mean FEV1 56% predicted), the investigators also collected other data expected to be predictive, including [... read more]
12 articles on emergencies (initial management) and postoperative problems. Curr Opin Crit Care 2011;17:317-407. (Special Issue, Review).
O’Connor et al report results of a randomized trial of 7,141 people with acute decompensated heart failure who got nesiritide or placebo in addition to standard care. To sum up, nesiritide didn’t seem to do much of anything at all (for dyspnea, risk of rehospitalization or death, or any other endpoint). NEJM 2011;365:32-43.
Under mandate by the FDA to answer lingering questions about long-acting beta agonists’ safety for treatment of asthma, four major pharma firms will launch five large randomized trials comparing inhaled corticosteroid / long-acting beta agonist combination products vs. ICS alone. The trials (4 in adults, 1 in kids) will enroll >50,000 people starting this year, [... read more]
Planer et al randomized 151 smokers admitted for acute coronary syndrome to receive either bupropion sustained-release or placebo for 8 weeks. There was no difference in abstinence rates at 3, 6, or 12 months. Those who had an invasive procedure during hospitalization were 4 times more likely to quit, though. (n=151) Arch Intern Med 2011;171:1055-1060.
Hashimoto et al randomized 95 adults taking chronic prednisone for severe asthma to usual care or home-tapering guided by spirometry, exhaled nitric oxide (from hand-held devices) and a symptom diary. The self-tapered group used significantly less prednisone without a worsening in symptoms (primary endpoint), hospitalizations or exacerbations (2′ endpoints). (n=95) Thorax 2011;66:514-520.
Inactivity has not yet been shown to increase risk for VTE, until now. Among 69,000 women in the Nurses Health Study 1990-2008, the cohort that spent the most time sitting experienced twice as many pulmonary emboli as the cohort that spent the least time sitting, with a hazard ratio of 2.34 after mulitvariate analysis, report [... read more]
Lu et al randomized 40 patients with Pseudomonas ventilator-associated pneumonia in France to receive ceftazidime & amikacin, either intravenously or by nebulizer for 8 days. There were no differences in treatment success or documented superinfection by other bugs. AJRCCM 2011;184:106-115. Enrollment began when microbiologic VAP was diagnosed (i.e., when BAL/mini-BAL culture results came back) and [... read more]
Geller et al randomized 151 cystic fibrosis patients with chronic Pseudomonas infection to receive nebulized levofloxacin (at 1 of 3 dosing levels) or placebo for 28 days. All treated groups had a reduction in sputum Pseudomonas density, the primary outcome, and the highest dose had a 1-log drop. FEV1 was 9% better than placebo in [... read more]
Parent et al report that among 398 people with sickle cell disease, the prevalence of pulmonary hypertension seemed to be 27% by echocardiography. By right heart catheterization, it was 6%. NEJM 2011;365:44-53.
Widespread beliefs among physicians that people with mental illness are more addicted, or less desirous or capable of quitting smoking, are wrong and perpetuate a deadly problem, argues J.J. Prochaska. You should nag mentally ill folks to quit smoking as you would anyone else, she urges. NEJM 2011;365:196-198. FULL FREE TEXT
Kuniyoshi et al prospectively observed people admitted to Mayo for myocardial infarction, performing polysomnography and measuring flow-mediated dilation in their brachial arteries. A whopping 69% (45 of 64) were found to have obstructive sleep apnea. Those with moderate to severe OSA had poorer arterial responsiveness, a surrogate marker for subsequent cardiovascular risk, compared to people [... read more]
In a great essay, Coller proposes re-engineering the health care system before Obamacare amplifies our skyrocketing cost problem under fee-for-service. Sounds like a twist on accountable care organizations, but more plausible and on its face politically palatable (after the bloody noses heal). JAMA 2011;306:204-205.
Low et al took 320-slice CT scans of the larynxes of 46 people with severe asthma throughout the respiratory cycle. They decided that 23 (50%) had abnormal narrowing of the vocal cords during either inspiration or expiration, and in 9 (19%) the narrowing was severe. This is an experimental modality so the clinical implications are [... read more]
King et al report a series of 80 otherwise healthy young vets who failed a 2-mile run fitness test due to dyspnea at Fort Campbell, KY. Many had been exposed to sulfur fires or other inhalational exposures. Among 49 who underwent open lung biopsy, 38 had constrictive bronchiolitis, an extremely rare condition in otherwise healthy [... read more]
Among ~26,000 patients discharged from 129 VA hospitals for COPD exacerbation, those living in isolated rural areas had a 5.0% 30-day mortality, compared to 3.8% for those living in urban areas. Those in not-so-isolated rural areas didn’t seem to be at elevated risk, report Abrams et al. Ann Intern Med 2011;155:80-86.
Particulate matter causes cardiovascular deaths, and also worsens respiratory illness. The Environmental Protection Agency plans to reduce acceptable levels of PM and ozone, a move that would force industry to pay for new upgrades. NEJM 2011;365:198-201.
The 18,000 clinical trials published each year aren’t doing much to improve human health, argues Peter Pronovost. Health delivery research can, by improving delivery and impact of already-proven interventions. But doing so will require cutting a slice of the funding pie for social scientists and other untouchables in the “omics”-loving academic caste system. JAMA 2011;306:310-311.