How “hard” should we “hit” our patients with Lasix? And does that hurt? Felker et al asked that (sort of) in a NHLBI-funded trial. They gave furosemide to 308 patients hospitalized for ADHF in an IV dose either equivalent to their home dose, or at 2.5 times their home dose, and either at q12-hour intervals [… read more]
In a rare encouraging positive study in the chronically critically ill, 71% of vent-dependent patients (~6 weeks on MV) who did multiple sets of daily inspirations backwards through a PEEP valve weaned from mechanical ventilation (defined as >72 hrs off the vent), vs. 47% receiving a sham treatment. MIP also improved by 10 cmH2O in [… read more]
Tashkin et al randomized 504 patients at 27 centers with COPD and FEV1 > 49% to varenicline or placebo for 12 weeks, with 52 weeks follow up. Smoking cessation / abstinence rate (carbon monoxide-confirmed) was 42% vs 9% in weeks 9 – 12 (1′ endpoint), and 19% vs. 6% in weeks 9 – 52 (p<0.0001). [… read more]
The once-daily beta-agonist was better than placebo and at least as good as twice-daily salmeterol, as measured by the SGRQ, TDI, and FEV1 after 12 weeks. The drug previously matched up well against tiotropium. Indacaterol is available in Europe, but not in the U.S. (n=838). ERJ 2011;37:273-279.
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]
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]
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]
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.
Patients with on-site evaluation of TBNA samples had fewer sites sampled (1 vs. 2) and general complications (6% vs. 20%), with an equivalent yield compared to patients undergoing usual TBNA (n=168). CHEST 2011;139:395-401.
12 months of nebulized gentamicin (80 mg bid) markedly reduced symptoms, exacerbations, and bacterial density in people with bronchiectasis from causes other than cystic fibrosis. None of these benefits were sustained after 3 months without therapy, though. (n=65). AJRCCM 2011;183:491-499.
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]