Feb 252011
 

DeMets & Califf give a historical play-by-play, lament the current state of affairs, and issue a call to arms for academics to leverage the current political climate favoring comparative-effectiveness and translational research, in order to build a new clinical trials edifice that favors the public’s health over profits. JAMA 2011;305:713-714.

Feb 222011
 

The IASLC, ATS, and ERS got together to better incorporate clinical logic into classification of NSCLC. No more bronchioloalveolar carcinoma (they propose adenocarcinoma in situ or invasive mucinous adenocarcinoma, depending on its size). Large cell carcinoma with neuroendocrine features gets separated out of NSCLC entirely, so it can be treated as small cell. And so [… read more]

Feb 212011
 

Song et al retrospectively reviewed 461 cases of IPF (269 biopsy-proven) in Korea. More than a third of patients were hospitalized for respiratory deteriorations over a 2-year period. About half the deteriorations were attributed to acute exacerbations of IPF, with most of the rest attributed to infections (half the patients had BAL and/or ET aspirates [… read more]

Feb 202011
 

Aduen et al performed simultaneous echocardiograms and right heart catheterizations on 117 patients, concluding echo is more accurate and precise than others previously found. They also promote a method of calculating and reporting mean PA pressure on echo, rather than systolic PA pressure. Right heart catheterization remains indispensable as the gold standard. CHEST 2011;139:347-352

Feb 192011
 

People (n=21) with inadequately controlled asthma in a supervised exercise program for 12 weeks followed by self-motivated exercise for 12 weeks had “clinically significant” 0.5-point lower scores on the Asthma Control Questionnaire, as well as improved aerobic fitness, compared to 16 nonrandomized matched controls. Astonishingly, no serious trial testing exercise in asthma control has ever [… read more]

Feb 182011
 

McCormack et al randomized 89 women with lymphangioleiomyomatosis to receive 2 mg rapamycin or placebo daily for 12 months, followed by 12 months of drug-free observation. Women receiving sirolimus had stable lung function on spirometry, fewer symptoms, fewer “respiratory events,” and better quality of life during the treatment period. This was tempered by GI, dermatologic, [… read more]

Feb 172011
 

Daily inhaled corticosteroids (ICS) may retard growth in children, who would rather play than take daily inhalers. Martinez et al randomized children with mild persistent asthma to four groups, one of which was beclomethasone + albuterol as rescue therapy only (i.e., no daily ICS), for 44 months. They did slightly worse than children taking daily [… read more]

Feb 162011
 

Ciclesonide, a new inhaled corticosteroid that seems to cause thrush less often than others, reached for equivalency with salmeterol/fluticasone in mild persistent asthma. Ciclesonide was better than placebo in controlling asthma but Advair users had a longer time to first asthma exacerbation. CHEST 2011;139: online supplement. A Cochrane review on ciclesonide could not establish its [… read more]

Feb 152011
 

In a very small trial (n=24), inhaled RNA (ALN-RSV01) appeared to improve outcomes in lung transplant patients with RSV respiratory infections, by interfering with viral replication. Symptoms were reduced, and at 90 days, incidence of bronchiolitis obliterans syndrome was 6% vs 50% in the control group. AJRCCM 2011;183:531-538.

Feb 122011
 

Louie et al report results of a phase 3 industry-funded trial of fidaxomicin, a poorly absorbed oral macrolide that’s bacteriocidal vs C. difficile. The new drug was equivalent to oral vanco in curing C.diff infections (~90%), and superior at preventing recurrences (~14% vs 24%). It did not prevent recurrences of the more lethal and increasingly [… read more]

Feb 092011
 

The hygiene hypothesis got a boost from Ege et al, who analyzed dust from 16,000 European children’s bedrooms and mattresses (stored with clinical/demographic data in two huge repositories, GABRIELA and PARSIFAL), for bacterial DNA or growth on bacterial/fungal culture media. Children living on farms had odds ratios for asthma of 0.49 to 0.76, compared to [… read more]

Jan 162011
 

ICU patients have a 5-10% risk of deep venous thrombosis, even with appropriate prophylaxis. Ultrasound screening can detect many of these asymptomatic and clinically unsuspected DVTs. However, since many DVTs disappear without incident, and complications can result from additional testing and treatment with anticoagulation, and all of this costs money, the best approach to prevention [… read more]