PulmCCM

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

Aug 062011
 

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]

Aug 052011
 

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]

Jul 292011
 

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.

Jul 252011
 

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]

Jul 242011
 

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.

Jul 242011
 

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.

Jul 212011
 

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]

Jul 202011
 

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.

Jul 202011
 

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]

Jul 192011
 

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.

Jul 182011
 

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.

Jul 172011
 

Anraku et al report a series of 40 patients previously treated for lung cancer who underwent endobronchial ultrasound guided transbronchial needle aspiration for new mediastinal or hilar abnormalities between 2008-2010 at University of Toronto. After EBUS-TBNA of mediastinal/hilar lymph nodes, 28 of 40 were found to have lung cancer. In 21, an identical cell type [… read more]

Jul 152011
 

3% saline infusions have become standard care for increased intracranial pressure at many centers, based on mostly anecdotal evidence. Hauer et al looked retrospectively at 100 patients receiving 3% saline for severe stroke in 2008-2009 (intracerebral hemorrhage, subarachnoid hemorrhage, or ischemic) and compared them to 115 historical controls, 2007-2008 with “equal” underlying disease. Hypertonic saline [… read more]