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]

Jul 032010
 

Priou et al followed 130 patients with OHS after initiation with noninvasive positive pressure ventilation. Mean follow up was 4 years. Most (96) were started on NPPV in the stable state; 38 had had an acute hypercapneic exacerbation. Survival at 1 year was 97.5%; 2 years (93%); 3 years (88%); 5 years (77%). The large [… read more]

Jan 242008
 

Meade MO et al. (Lung open ventilation study investigators) Ventilation strategy using low tidal volumes, recruitment maneuvers, and high positive end-expiratory pressure for acute lung injury and acute respiratory distress syndrome: a randomized controlled trial.  JAMA 2008; 299:637-45. Higher PEEP provided no benefit in 28-day mortality (28 vs 32%, p = 0.2), although it reduced refractory hypoxia (~5% [… read more]

Aug 242004
 

Brower RG et al. Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med 2004;351:327-36.  Randomized trial among 549 patients with ARDS/ALI conducted by NHLBI/ARDSNet. Compared high and low PEEP strategies, and found no significant difference in mortality, ventilator-free days, ICU-free days, or organ failure-free days between [… read more]

May 242003
 

Herridge MS et al. One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med. 2003; 348:683-93. Non-pulmonary problems are usually dominant in impairment of ARDS survivors. Low exercise tolerance, fatigue, and weakness are common a year after discharge. Pulmonary function tests usually normalized, other than a diffusion impairment. At 12 months, only 6% [… read more]