PulmCCM

The PulmCCM team writes the posts under this moniker. Read the About page for more of the PulmCCM story.

Oct 242018
 
FDA approves dupilumab, injectible biologic, for eosinophilic asthma

The US Food and Drug Administration (FDA) approved dupilumab (Dupixent, Sanofi/Regeneron) as “add-on maintenance therapy in patients with moderate-to-severe asthma aged 12 years and older with an eosinophilic phenotype or with oral corticosteroid-dependent asthma,” according to the manufacturer’s news release. In randomized trials, asthmatic patients with higher blood eosinophil counts (≥ 150 cells/µL) failing corticosteroid [… read more]

Oct 232018
 
Antipsychotics don't help in ICU delirium: MIND-USA

Neither typical antipsychotics (haloperidol) or newer antipsychotics (ziprasidone) were effective in treating delirium in critically ill patients, in a major randomized trial. The results call into question widely used pharmacologic treatments for ICU delirium. Authors enrolled 1,183 adult patients at medical or surgical ICUs at 16 U.S. medical centers who developed delirium while critically ill [… read more]

Oct 172018
 
Seven days (or fewer) of corticosteroids advised for severe COPD exacerbations: GOLD

How many days of steroids should be taken by people with COPD exacerbations severe enough to require hospitalization? In 2013, the REDUCE trial (JAMA) suggested five days of systemic corticosteroids are as good as longer 10-14 day courses, among 314 patients hospitalized with severe COPD exacerbations. This contradicted the prevailing GOLD guidelines at the time, [… read more]

Oct 142018
 
Procalcitonin strategy in the ED did not reduce antibiotic use (ProACT)

Procalcitonin-driven algorithms did not lead to lower antibiotic use for suspected pneumonias in the emergency department, in a large randomized trial. The multicenter ProACT trial enrolled 1,656 patients presenting with symptoms of pneumonia at multiple emergency departments. Patients were randomized to receive care guided by procalcitonin results (with thresholds to guide initiation or withholding of antibiotics), [… read more]

Oct 042018
 
Targeting normal oxygen saturation associated with death: meta-analysis

A new meta-analysis adds to the evidence that liberal use of supplemental oxygen may be harmful in acutely ill, hospitalized patients. Authors performed a meta-analysis of 25 randomized trials of acutely ill patients (total n ~ 16,000) treated with strategies of either “low” or “high” supplemental oxygenation. Although the cutoffs varied between studies, patients receiving [… read more]

Oct 022018
 
Dentists may be at high risk for idiopathic pulmonary fibrosis, data suggest

The CDC warned in its Morbidity and Mortality Weekly Report that dentists may be at significantly higher risk for developing idiopathic pulmonary fibrosis, compared to the general population. In a sample of 894 patients with IPF with records over 20 years at a Virginia specialty clinic, CDC discovered that 8 dentists (and one dental technician) [… read more]

Sep 262018
 
Endobronchial valves now FDA approved for severe COPD

In the lungs of patients with severe emphysema (COPD), relatively large spaces previously containing lung tissue (obliterated by smoking) become filled with stagnant air that doesn’t circulate with breathing. This ominously-named “dead-space ventilation” reduces the overall mechanical efficiency of breathing, often causing disabling dyspnea. Lung volume reduction surgery (cutting out the dead space, usually at [… read more]

Sep 172018
 

by Salynn Boyles, MedPage Today Contributing Writer Treatment with the first approved once-daily, single inhaler triple therapy for COPD resulted in a significantly lower rate of exacerbations, as well as better lung function and quality of life compared to dual therapy in patients with a history of exacerbations, researchers reported. Results from the huge IMPACT trial supported an [… read more]

Sep 132018
 
ECMO fails as first-line treatment for ARDS. Or did it?

Extracorporeal membrane oxygenation (ECMO) is an accepted salvage therapy for severe acute respiratory distress syndrome (ARDS) after conventional mechanical ventilation with low tidal volumes, neuromuscular blockade and prone positioning have failed. ECMO has been proposed as the ultimate lung protection strategy for ARDS, because it bypasses the lungs entirely. So why shouldn’t it be first-line [… read more]

Sep 132018
 
New MRI technology could predict outcome after cardiac arrest

Brain damage with severe cognitive and functional impairment are common after cardiac arrest, but far from universal. Even after thorough testing, most comatose patients receive an indeterminate neurologic prognosis post-arrest. Physicians faced with this uncertainty have a difficult task in counseling family members trying to make decisions to maximize their loved one’s chances for recovery [… read more]

Sep 052018
 
Subsegmental pulmonary embolism: anticoagulation or observation?

As the use of chest CT-angiograms in emergency departments and medical wards has risen by more than tenfold, so has the discovery of small pulmonary emboli of unclear clinical significance. These PEs are often isolated to distal (subsegmental) branches of the pulmonary artery, without concurrent deep venous thrombosis (DVT). Small distal PEs may be incidentally [… read more]

Aug 192018
 
Seven days of antibiotics were as good as 14 for gram-negative bacteremia

Two-week antibiotic courses have been considered standard care for most patients with bacteremia who do not have sepsis or an untreated primary source (e.g. endocarditis). No good evidence ever supported the practice, which was supported mainly by retrospective data in patients with sepsis. A new study suggests that treating gram-negative bacteremia for seven days is [… read more]

Aug 192018
 
Aspirin Appears Protective in COPD Patients

by Ed Susman, Contributing Writer, MedPage Today SAN DIEGO – Patients diagnosed with chronic obstructive pulmonary disease (COPD) who are also on aspirin therapy appear to have a lower rate of COPD exacerbations, researchers reported at the annual conference of the American Thoracic Society. The risk of experiencing any acute exacerbation of COPD was reduced by 18% among [… read more]

Aug 162018
 
Extended antibiotic infusions could save lives: Here's how to do it

By Thomas C. Neal, PharmD According to a meta-analysis of randomized trials, prolonged infusions of antipseudomonal beta-lactam antibiotics could save lives. However, obstacles to implementing pharmacodynamically optimized administration practices have slowed the adoption of this practice in most ICUs:1 The requirement for IV pumps, preferably smart IV pumps, is potentially problematic in resource-limited settings or on wards [… read more]

Aug 122018
 
Asthma patients should use ICS-LABA for rescue as well as maintenance, SMART says

In Europe, patients with asthma have long been advised to take more puffs of their combination inhaled corticosteroid-long-acting beta-agonist (ICS-LABA) inhaler during periods of increased asthma symptoms. In the U.S., patients are instead advised to use albuterol as their rescue inhaler, and stick firmly to the usual maintenance dose of ICS-LABA regardless of symptom severity. [… read more]

Aug 122018
 
Increasing inhaled steroids to abort asthma attacks: does it work?

When patients with asthma feel their symptoms worsening and fear a full-blown exacerbation is imminent, what should they do? Doctors and researchers have never found a good answer to this question for most patients. The options are, generally: 1) continue current controller inhalers and observing; 2) increase the dose of inhaled steroid inhalers; or 3) [… read more]

Aug 032018
 
Scheduled nebulization with acetylcysteine didn't help ventilated patients

by Salynn Boyles, Contributing Writer, MedPage Today Regular nebulization proved to be no more effective than nebulization on demand in a randomized trial involving critically ill patients receiving invasive ventilation, researchers reported. Among ICU patients expected to need invasive ventilation for at least 24 hours, scheduled nebulization four times a day involving acetylcysteine with salbutamol did not [… read more]

Jul 252018
 
FDA approves new hyperkalemia drug Lokelma

The FDA approved oral sodium zirconium cyclosilicate (ZS-9), to be marketed as Lokelma, for the treatment of hyperkalemia. The drug seems to work better than sodium polystyrene sulfonate (Kayexalate), reducing serum potassium levels within an hour and restoring normal levels after about 2 hours in most patients. The drug was tested against placebo (not Kayexalate) [… read more]