Drug and device companies finance up to 60% of all CME in the U.S. Tabas et al surveyed 1,347 CME participants, 770 of whom responded. 88% felt that industry involvement biased their educational program…but only 42% said they’d be willing to pay higher CME fees to help reduce commercial influence. Participants almost universally (85-88%) underestimated the real [... read more]
Jones et al randomized 1,647 people with moderate to severe COPD for the two trials, to receive either aclidinium inhaled (a potential tiotropium competitor) once daily or placebo for 1 year. Aclidinium improved FEV1 by ~65 mL. An absolute ~8% more people taking the drug achieved a 4-point SGRQ improvement over those taking placebo. Time [... read more]
Most clinical trials for asthma drugs exclude ~95% of potential subjects and test under highly controlled conditions, limiting their results’ generalizability. Price et al publish results of 2 “pragmatic” open-label trials set in the real world. In #1, they randomized 300 symptomatic asthmatics in 53 U.K. primary care clinics to get either a leukotriene receptor [... read more]
Singh et al’s meta-analysis of 13 randomized trials of pioglitazone or rosiglitazone lasting for at least one year. There were 130 pneumonias among the 8,163 treated patients, and 100 among the 9,464 controls, for a relative risk of 1.40 for the thiazolidinedione group (CI 1.1-1.8, p=0.01). Pioglitazone showed more of a signal with a significant RR of [... read more]
Evans et al attempted a meta-analysis of 9 randomized trials (7 in adults) testing prolonged (4 to 52 weeks) antibiotics in people with bronchiectasis. There was an improvement in “clinical response rate,” a poorly-defined endpoint, in 2 trials, but no difference in exacerbation rates or lung function. Emergence of resistant bacteria was not tested or [... read more]
An attempted meta-analysis of 11 heterogeneous, moderate-quality randomized trials could demonstrate no benefit of incentive spirometry in preventing postoperative pulmonary complications or mortality, in 1,160 patients undergoing upper abdominal surgery, report Guimaraes et al. Cochrane Database Sys Rev 2011;3:CD006058.
Kuna et al randomized 296 veterans with suspected obstructive sleep apnea (OSA) to home sleep testing with a type 3 portable monitor followed by auto-titrating CPAP, or in-lab polysomnography and CPAP titration. After 3 months of CPAP treatment (in the 260 or 88% overall who did have OSA), surveyed functional outcomes were identical between groups, [... read more]
Acute lung injury & critical care update for 2010: Vadasz I, Sznajder J, AJRCCM 2011;183:1147-1152. ARDS review. Critical care review.
Janssen et alsurveyed and prospectively followed 105 Dutch patients with severe COPD and 80 with severe heart failure. Seventy percent of the respondents with COPD wanted full life support in the event of an arrest; ~64% of the CHF patients did. Sixteen to 20% of the doctors reported they had discussed these issues. However, only 4-6% [... read more]
Prone positioning improves oxygenation in ARDS patients without improving outcome. Recruitment maneuvers do too. Rival et al prospectively tested the effects of both strategies together in 16 ARDS patients. Two extended sighs of 45 cm H2O in pressure control mode while lying prone improved PaO2/FiO2 from 98 to 166 mm Hg, without obvious adverse (or positive) effects. Critical [... read more]
Antibiotic dosing in multiple organ dysfunction syndrome: Ulldemolins et al, CHEST 2011;139:1210-1220.
Invasive aspergillosis is often lethal in lung transplant patients, and early diagnosis and treatment improve survival. Luong M et al showed that testing bronchoalveolar lavage fluid with new rapid-result Aspergillus PCR and galactomannan tests bring both sensitivity and specificity into the 93-100% range. 150 BAL samples from lung transplant patients at Pitt were tested (there were only [... read more]
Protti et al ventilated 29 healthy pigs for 2 days, each at a point on a range of “strain” (tidal volume divided by functional residual capacity). Ventilator-induced lung injury only occurred at strains 1.5-2 or greater (tidal volumes in the >30 mL/kg range). Although pigs’ lungs are inherently different than ours, authors make the believable argument that [... read more]
COPD Update for 2010: Han MK, AJRCCM 2011;183:1311-1315. COPD review.
In an observational study of 210 patients undergoing resection for lung cancer, those with a peak oxygen uptake (VO2 max) of <10 mL/kg/min were 4 times more likely to have cardiac or pulmonary complications than those with a VO2 > 17. ERJ 2011;37:1189-1198.
A retrospective and somewhat subjective case series (n=39) reporting successful reduction in steroid doses in those with a diagnosis of difficult asthma who were found to have non-pulmonary causes of dyspnea on CPET. CHEST 2011;139:1117-1123.
Degree of overventilation during exercise predicts bad outcomes in heart failure: Sue D, AJRCCM 2011;183:1302-1310. CPET review.
Complete mediastinal lymph node dissection (MLND) is recommended during all surgical reactions of lung cancer — yet “complete” has never been defined, and in a community study, 43% of patients got no MLND. In prospective randomized clinical trial data on 524 patients, Darling et al found that 99% of patients had at least 6 LNs removed, and 90% had 10 [... read more]
Retrospectively looking at a database of 5,977 COPD patients’ hospital admissions (TARDIS), pharmacy data, and death records in Scotland, Short et al found an overall 22% lower mortality in those taking beta blockers (88% were cardioselective BBs). The benefit was seen equally in those also taking long-acting beta agonists or antimuscarinics. For those 2,712 patients with serial [... read more]
Diagnostic value of halo and reversed-halo signs in immune-compromised hosts. Georgiadou SP et al, Clin Infect Dis 2011;52:1144-1155. Review.