Author Interviews, Critical Care - Intensive Care - ICUs, Pulmonary Disease / 06.09.2016

MedicalResearch.com Interview with: Hayley B. Gershengorn, MD Associate Professor, Albert Einstein College of Medicine Attending Physician, Montefiore Medical Center Bronx, NY 10467 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Little was previously known about the timing of extubations for mechanically ventilated intensive care unit patients or whether extubating patients overnight is safe. In this retrospective cohort study of mechanically ventilated intensive care unit adult patients in the United States, 20.1% were extubated overnight. Overnight extubation was associated with significantly higher hospital mortality. (more…)
Author Interviews, JAMA, Obstructive Sleep Apnea, Pulmonary Disease, Sleep Disorders / 11.08.2016

MedicalResearch.com Interview with: Ken Kunisaki, MD, MS Associate Professor of Medicine Minneapolis Veterans Affairs Health Care System and University of Minnesota and Roxanne Prichard, PhD Associate Professor of Psychology and Neuroscience University of St. Thomas MedicalResearch.com: What is the background for this study? What are the main findings? Response: CPAP devices, or continuous positive airway pressure devices, are used to treat obstructive sleep apnea, a common condition that causes people to intermittently stop breathing during their sleep. This leads to poor sleep quality and often results in symptoms like excessive sleepiness in the daytime. In the United States, CPAP devices are classified by the Food and Drug Administration as Class II medical devices with possible risks; their sale requires a medical prescription. We were aware of online advertisements for secondhand, used CPAP machines, but we have not seen publications that have analyzed this practice. Once a week, our research team monitored online advertisements for secondhand CPAP devices on Craigslist.org in 18 U.S. cities and areas over a one-month period. During that time, we found 270 advertisements, most of which did not describe who previously had used the device or why it was being sold. Only 5 of the advertisements mentioned anything about the legal requirements of a prescription and 61 percent of the devices included a used mask without information about its age or how it was cleaned. CPAP devices create air pressure and attach to a nose or face mask that delivers that pressure to a patient’s airway, thereby keeping him or her breathing during sleep. The amount of air pressure delivered by the devices is adjusted for each patient and usually is determined by a medical exam that includes an overnight stay in a laboratory. Our study found that most of the Craigslist advertisements failed to mention the devices’ pressure settings—settings that were prescribed for the original owners. The average price for a CPAP device listed on Craigslist was $291, much less than the $600 to $2,000 cost of a new device. (more…)
AHA Journals, Author Interviews, Cannabis, Pulmonary Disease, UCSF / 27.07.2016

MedicalResearch.com Interview with: Matthew L. Springer, Ph.D. Professor of Medicine Division of Cardiology University of California, San Francisco San Francisco, CA MedicalResearch.com: What is the background for this study? Response: We've known for many years that secondhand smoke from tobacco cigarettes is harmful, and the vast majority of deaths thought to result from secondhand smoke are from cardiovascular disease. However, very little has been known about cardiovascular consequences of exposure to secondhand smoke from marijuana, and people tend to mistake the lack of evidence that it is harmful, for evidence that is it not harmful. As a result, many people seem relatively unconcerned about smoking marijuana and being exposed (or exposing others) to marijuana secondhand smoke. Politicians and policy makers also seem less willing to limit where people can smoke marijuana (under legal circumstances) than tobacco. What has been lacking is research into how exposure to marijuana smoke affects cardiovascular health. It has been difficult to do such experiments because marijuana is illegal in the eyes of the federal government. However, we have been studying the harmful effects of secondhand tobacco smoke on the function of rat blood vessels, which is similar to its harmful effects on human blood vessels, and we now have studied how the function of rat blood vessels is affected by exposure to secondhand marijuana smoke. (more…)
Author Interviews, Immunotherapy, Pulmonary Disease / 20.07.2016

MedicalResearch.com Interview with: Ganesh Raghu, M.D. FACP, FCCP Professor of Medicine Division of Pulmonary and Critical Care Medicine and Director of Center for Interstitial Lung Diseases Director, Interstitial Lung Disease/Sarcoid/Pulmonary Fibrosis Program University of Washington Medical Center Seattle, Washington MedicalResearch.com: What is the background for this study? Response: This is a new post-hoc analysis of the Phase III INPULSIS trials, including a total of 1,061 patients with idiopathic pulmonary fibrosis (IPF), which has been published in the American Journal of Respiratory and Critical Care Medicine. As background, achieving an accurate diagnosis of IPF in clinical practice is very complex and challenging. Physicians use an imaging technique called high resolution computed tomography (HRCT) to help them identify the presence of scarring (fibrosis) and, specifically, the presence of usual interstitial pneumonia (UIP) pattern in the lungs. The radiological changes called "honeycombing" are the key feature of the UIP pattern visible on HRCT and the pattern of UIP is the hallmark of the fibrosis in patients with IPF. In the absence of definitive UIP pattern on HRCT images of the lungs, the diagnosis of  idiopathic pulmonary fibrosis requires the microscopic features of UIP in the surgical lung biopsy (SLB) based on current guidelines for diagnosis of IPF. However, it can be challenging to confirm that scarring in the absence of honeycombing on HRCT meets the strict guideline criteria for a definitive diagnosis of IPF. For a large group of patients who do not receive a confirmed diagnosis of IPF according to guidelines, including those not eligible for surgical lung biopsy, the clinical course of their condition and the effectiveness of  idiopathic pulmonary fibrosis treatment remains unknown. Therefore, investigations into the behavior of the disease across diagnostic subgroups are important. (more…)
Author Interviews, Infections, Microbiome, Pulmonary Disease / 06.07.2016

MedicalResearch.com Interview with: Genevieve Marchand Ph.D., RMCCM SCCM(Env) Microbiologiste agréée & Biochimiste Chercheure, Prévention des risques chimiques et biologiques IRSST MedicalResearch.com: What is the background for this study? Response: It is well known that Health Care Workers (HCWs) are at risk of occupationally acquired infections. Some procedures, such as bronchoscopies, are recognized to be high-risk tasks. Most researches that have linked infectious risk to specific task in healthcare settings did not measure the real bioaerosol exposure. Those link where mostly made from epidemiology observations. The aim of this study was to qualify and quantify the real bioaerosol concentrations found during bronchoscopy procedures in order to estimate the true occupational risk. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, JAMA, Pulmonary Disease / 28.06.2016

MedicalResearch.com Interview with: Peter E. Morris, MD, FACP, FCCP Chief, Division of Pulmonary, Critical Care and Sleep Medicine University of Kentucky Lexington, KY MedicalResearch.com: What is the background for this study? What are the main findings? Response: ICU survivors demonstrate weakness. It has been postulated that interventions to promote early rehabilitation strategies might be linked to improved functional outcomes for ICU survivors. This study was based upon findings from a quality improvement endeavor that linked early rehabilitation with indications of shortened hospital stays for ICU survivors. (more…)
Author Interviews, Cannabis, CHEST, Pulmonary Disease / 12.06.2016

MedicalResearch.com Interview with: Stefania I. Papatheodorou, MD, PhD Cyprus International Institute for Environmental and Public Health Limassol, Cyprus MedicalResearch.com: What is the background for this study? What are the main findings? Response: Marijuana is the most commonly used illicit drug in the United States. Despite increasing use and acceptance of marijuana, both medically and recreationally, gaps remain in our knowledge regarding potential health effects. In this study, we aimed to evaluate associations between recent marijuana use, exhaled Nitric Oxide (eNO) and pulmonary function. We performed a cross-sectional study of 10,327 US adults participating in the National Health and Nutrition Examination Survey (NHANES) in the years 2007 to 2012. Exhaled Nitric Oxide was lower among participants who used marijuana in the past 0 to 4 days and those who last used marijuana 5 to 30 days before the examination compared with the never users. FEV1 was higher among participants who used marijuana within 0 to 4 days before the examination compared with those who never used marijuana, while FVC was higher in both past and current marijuana users compared with never users. The FEV1/FVC ratio was significantly lower among those who used marijuana in the 0 to 4 days before the examination compared with never users. (more…)
Asthma, Author Interviews, NEJM, NIH, Pediatrics, Pulmonary Disease / 18.05.2016

MedicalResearch.com Interview with: Dr. James P. Kiley Ph.D National Institutes of Health Bethesda Maryland  MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Kiley: While a higher proportion of children have asthma compared to adults, the disease is limited to childhood for many individuals who appear to be unaffected as adults. Regardless of whether asthma continues into adulthood or reoccurs during adulthood, the impact of childhood asthma on lung function later in life is unclear. This study demonstrated that in children with chronic persistent asthma at the age of 5-12 years who continued to be followed through their early twenties, 75% of them had some abnormality in the pattern of their lung growth. The study examined the trajectory of lung growth, and the decline from maximum growth, in a large cohort of persons who had persistent, mild-to-moderate asthma in childhood and determined the demographic and clinical factors associated with abnormal patterns of lung growth and decline. (more…)
Asthma, Author Interviews, Brigham & Women's - Harvard, NEJM, Pediatrics, Pulmonary Disease / 15.05.2016

MedicalResearch.com Interview with: Michael McGeachie, PhD Instructor in Medicine Harvard Medical School Channing Division of Network Medicine Brigham and Women's Hospital MedicalResearch.com: What is the background for this study? Dr. McGeachie: In asthma, and in general but particularly in asthma, a person’s level of lung function has a big impact on his or her quality of life, level of respiratory symptoms and complications, and general morbidity. In asthma, low lung function leads to greater severity and frequency of asthma symptoms. Asthma is a common childhood illness, affecting 9-10% of children. Many children grow out of asthma as they become adults, but other asthmatics remain effected through adulthood, which can lead to a lifetime of respiratory symptoms and chronic airway obstruction, including chronic obstructive pulmonary disease (COPD). If you consider lung function longitudinally, throughout development, plateau, and decline, different people and different asthmatics tend to exhibit different patterns of lung function. Healthy, non-asthmatic people tend to have a period of rapid lung function increase in adolescence, a plateau of lung function level in their late teens and early 20s, and starting around 25 or so a slow, gradual decline of lung function that continues throughout old age. We call this Normal Growth of lung function. However, some people exhibit Reduced Growth, where they don’t reach their expected maximum lung function for a person of the same age, sex, height, and race. Others can show Early Decline, who might reach a normal maximum but then begin to decline immediately without a plateau or with a truncated plateau. We hypothesized that these patterns, Reduced Growth and Early Decline, might have different baseline indicators, precursors, outcomes, and risk of developing COPD. (more…)
Author Interviews, Biomarkers, Lancet, Pulmonary Disease / 25.04.2016

MedicalResearch.com Interview with: Danny McBryan, MD Vice president, Clinical Development & Medical Affairs, Respiratory Boehringer Ingelheim Pharmaceuticals, Inc. MedicalResearch.com: What is the background for this study? What are the main findings? Dr. MvBryan: The new post-hoc analysis from the WISDOM study shows a routine blood test could help identify the small minority of patients with severe or very severe COPD who may benefit from the addition of inhaled corticosteroids (ICS). This post-hoc analysis was recently published online in The Lancet Respiratory Medicine. For 80 percent of patients in the WISDOM study, the use of ICS on top of SPIRIVA HANDIHALER (a long-acting muscarinic antagonist – LAMA) and salmeterol (a long-acting beta-agonist – LABA) had no additional benefit in reducing the risk of exacerbations, compared to SPIRIVA HANDIHALER and the LABA without ICS. The post-hoc analysis shows that these patients can be easily identified by measuring the level of white blood cells, called eosinophils. Patients with levels lower than 4 percent (300 cells/µL) were associated with a lack of response to ICS. The WISDOM study evaluated stepwise withdrawal of inhaled corticosteroids (ICS) in severe to very severe COPD patients with a history of exacerbation. WISDOM was a 12-month, double-blind, parallel-group, active-controlled study in which all patients received triple therapy (tiotropium 18 μg once daily, salmeterol 50 μg twice daily and fluticasone 500 μg twice daily) for a six-week run-in period. Patients were randomized 1:1 to continue triple therapy or stepwise withdrawal of ICS over 12 weeks (dose reduction every six weeks). The WISDOM data show that in patients with severe to very severe COPD, the risk of moderate/severe exacerbations during one year of follow-up was non-inferior between those patients who continued on inhaled corticosteroids and those where ICS therapy was withdrawn in a stepwise manner. (more…)
Author Interviews, Biomarkers, Lancet, Pulmonary Disease / 14.04.2016

MedicalResearch.com Interview with: Dr Henrik Watz MD Pulmonary Research Institute at Lung Clinic Grosshansdorf Airway Research Center North, German Center for Lung Research Grosshansdorf, Germany Medical Research: What is the background for this study? What are the main findings? Dr Watz : While bronchodilators are the mainstay therapy for all patients with COPD some patients benefit from the addition of inhaled corticosteroids in case of frequent exacerbations. So far only little data exist that help clinicians to better characterize those patients that may benefit from the continuation of inhaled corticosteroids on top of dual bronchodilation with a LABA and a LAMA. Post-hoc analyses of the WISDOM dataset suggest that those patients, who have blood eosinophil counts of 4 % or greater or 300 eosinophils per µL or more have less exacerbations, when inhaled corticosteroids are continued compared to patients, in whom inhaled corticosteroids are withdrawn. Patients with less than 4 % eosinophils or less than 300 eosinophils in peripheral blood, who represent 80 % of the study population in WISDOM, did not benefit from a continuation of inhaled corticosteroids. (more…)
Author Interviews, JAMA, Pulmonary Disease, Smoking / 07.04.2016

MedicalResearch.com Interview with: Dr. William Phillips MD MPH USPSTF  Task Force member and Theodore J. Phillips Endowed Professor in Family Medicine University of Washington, Seattle. Dr. Phillips is also a founder and senior associate editor of the Annals of Family Medicine MedicalResearch.com: What is the background for this study? What are the main findings?  Dr. Phillips: Chronic obstructive respiratory disease, or COPD, is a serious, chronic condition that affects a person’s ability to breathe. It is the third leading cause of death in the United States. When the Task Force reviewed the research on screening adults for COPD in a primary care setting, we concluded with moderate certainty that screening has no net benefit, which is why we do not recommend screening for COPD in people who do not have symptoms. (more…)
Allergies, Asthma, Author Interviews, OBGYNE, Pulmonary Disease / 05.04.2016

MedicalResearch.com Interview with: Anick Bérard PhD FISPE Research chair FRQ-S on Medications and Pregnancy and Director Réseau Québécois de recherche sur le médicament (RQRM) and Professor, Research Chair on Medications, Pregnancy and Lactation Faculty of Pharmacy,University of Montreal and Director, Research Unit on Medications and Pregnancy Research Center CHU Ste-Justine MedicalResearch.com: What is the background for this study? What are the main findings? Response: Intranasal corticosteroid (Nasacort) use during pregnancy for the treatment of seasonal allergies has increased over the past decade. Nasacort is now available over the counter since October 2013 in the US and January 2015 in Canada. Given that seasonal allergies are prevalent during pregnancy and that a medication available over-the-counter is likely to be used frequently, we aimed to study the risk of using Nasacort during gestation. Furthermore, given the potential public health impact, the objectives of our study were to assess the safety of intranasal triamcinolone exposure during pregnancy on the occurrence of major congenital malformations, small-for-gestational-age (SGA) newborn, and spontaneous abortions. Use of intranasal triamcinolone during the first trimester of pregnancy was not significantly associated with the risk of overall congenital malformations (OR 0.88, 95%CI 0.60-1.28; 31 exposed cases) compared to non-exposure; it was however associated with the risk of respiratory defects (OR 2.71, 95%CI 1.11-6.64; 5 exposed cases). This is important given that a medication given for the treatment of respiratory diseases is associated with respiratory defects in newborns. Pregnancy exposure to intranasal triamcinolone was not significantly associated with the risk of spontaneous abortions (OR 1.04, 95%CI 0.76-1.43; 50 exposed cases). No association was found between 2nd or 3rd trimester exposure to intranasal triamcinolone and the risk of SGA (OR 1.06, 95%CI 0.79-1.43; 50 exposed cases). (more…)
Author Interviews, Pulmonary Disease / 01.04.2016

MedicalResearch.com Interview with: Prof Michael Kreuter Center for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg and Translational Lung Research Center Heidelberg, Germany MedicalResearch.com: What is the background for this study? What are the main findings? Prof. Kreuter: Already in the 70s, early reports hypothesized a relationship between gastroesophageal reflux disease (GERD) and pulmonary fibrosis (IPF). Since then, clinical and preclinical data suggested that micro-aspirations cause lung parenchymal injuries which may stimulate pulmonary fibrosis. The hypothesis of a potential relationship between idiopathic pulmonary fibrosis (IPF_ and GERD also provoked the question of an effect of GERD-treatment by antacid therapy (i.e. proton pump inhibitors or H2-blockers) on the course of IPF.  In this context, two analyses, one retrospective and one post hoc, reported that antacid treatment had positive effects on the course of pulmonary function and on survival in IPF patients. These data lead to a conditional recommendation for the treatment of patients with IPF with antacid therapy in the current international IPF guideline. However, the low confidence in estimates of the effect prompted us to initiate a new post-hoc analysis pooling data from the placebo arms of three multinational trials on pirfenidone in interstitial pulmonary fibrosis. In this new analysis, published in Lancet Respiratory Medicine, antacid therapy was not associated with a slower disease progression in IPF. Moreover, in patients with advanced disease antacid therapy was associated with a significantly higher incidence of pulmonary and non-pulmonary infections. (more…)
Author Interviews, Pulmonary Disease / 01.04.2016

MedicalResearch.com Interview with – Professor Luca Richeldi University Hospital, Southampton Southampton, UK MedicalResearch.com: What is the background for this study? What are the main findings? Prof. Richeldi: The pooled analysis published in Respiratory Medicine is based on Ofev (nintedanib) data from the Phase II TOMORROW trial and the two Phase III INPULSIS studies, and a total of 1,231 patients with idiopathic pulmonary fibrosis (IPF), 723 of whom were treated with Ofev. The results of this analysis confirm that Ofev significantly slows disease progression by approximately 50%, as measured by decline in forced vital capacity (FVC) across a range of patient types in the clinical trial program. In addition, the analysis confirms that Ofev reduces the risk of acute exacerbations by approximately 50% and has a favorable effect across mortality outcomes with a trend in lower all-cause mortality and a significant lower on-treatment-mortality. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Pulmonary Disease, Surgical Research, Technology / 18.03.2016

MedicalResearch.com Interview with: Dr. Ariel Drori MD Hadassah Medical Center  MedicalResearch.com: What is the background for the ThoraXS device? Dr. Drori: The initial recognition of the need for a device like ThoraXS first came to me on an operational deployment during my reserve service where I serve as a military doctor. While serving on the Gazan border, I was called to a battle scene to treat a soldier who was suffering from pneumothorax after being shot in the chest.  A quick evacuation by helicopter meant that I didn't have the time to perform the entire procedure and I was forced to hand over a partially-treated patient whose condition was unstable. The reality of constant combat injuries mixed with a rising number of daily civilian terror attack casualties led us to understand that we need to provide a cheap, easy to use, robust and reliable solution that on the one hand can withstand the most extreme combat conditions and on the other, be used by any paramedic and in any pre-hospital and hospital setting. This line of thought eventually led to the adoption of ThoraXS's simple yet sophisticated mechanical mechanism that ticks all the boxes. (more…)
Author Interviews, Diabetes, Pulmonary Disease, Sleep Disorders / 15.03.2016

MedicalResearch.com Interview with: Jonathan Shaw MD, FRACP, FRCP (UK), FAAHMS Associate Professor Domain Head, Population Health Research Baker IDI Heart and Diabetes Institute Melbourne VIC 3004 MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Shaw: Over the last decade or so, there has been a lot of research connecting obstructive sleep apnoea with type 2 diabetes. They co-exist very frequently in the same individual, they are both much more common in overweight and obese people than in people of healthy weights, both improve with weight loss, and both are associated with other conditions such as hypertension and heart disease. In addition, there has been evidence that some of the key abnormalities occurring in sleep apnoea (in particular, fragmented sleep and intermittent low oxygen levels) may have a direct effect on glucose metabolism, and increase blood sugar levels. This led many people to suspect that untreated sleep apnoea might be one reason that type 2 diabetes is hard to control, and that treating sleep apnoea in people with type 2 diabetes would improve their blood sugar control. We, therefore, undertook a large trial among people with type 2 diabetes, and previously unrecognised sleep apnoea, in which participants were randomised to either a group receiving specific treatment for sleep apnoea (continuous positive airways pressure, or CPAP, therapy at night) or to a control group. Over the six months of the trial, we saw no benefit of CPAP therapy in regard to blood sugar control (as measured by HbA1c). Even when we looked at sub-groups with worse blood sugar control at the start or worse sleep apnoea or who did the best in terms of using CPAP every night, there was still no sign of benefit on blood sugar control. We did, however, see some other benefits of CPAP therapy, with less daytime sleepiness, improvements in quality of life and lower diastolic blood pressure. (more…)
Author Interviews, CMAJ, Outcomes & Safety, Pulmonary Disease, Respiratory / 08.03.2016

MedicalResearch.com Interview with: Dr. Gary Garber MD Chief of infection prevention and control Public Health Ontario Professor of medicine University of Ottawa  MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Garber: There are conflicting recommendations regarding the use of respirators vs face masks to protect healthcare workers against acute respiratory infections. Our systematic review and meta-analysis show that although N95 respirators have improved efficiency in reducing filter penetration under laboratory conditions, there is insufficient data to show a protective advantage compared to surgical mask in clinical settings. (more…)
Author Interviews, Emergency Care, Infections, JAMA, Pediatrics, Pulmonary Disease, Respiratory / 29.02.2016

MedicalResearch.com Interview with: Suzanne Schuh, MD, FRCP(C), ABPEM The Hospital for Sick Children affiliated with the University of Toronto Medical Research: What is the background for this study? Dr. Schuh: Routine measurement of oxygen saturation in bronchiolitis is sometimes used as a proxy for illness severity, despite poor correlation between these parameters. This focus on oximetry may in part relate to lack of evidence on the natural history of desaturations in bronchiolitis which are often transient, and frequently not accompanied by increased respiratory distress. Desaturations occurring in infants with mild bronchiolitis in an ED often result in hospitalizations or prolonged hospital stay. They occur in healthy infants and may also occur in infants with mild bronchiolitis at home. The main objective of this study of infants with acute bronchiolitis was to determine if there is a difference in the proportion of unscheduled medical visits within 72 hours of ED discharge in infants who desaturate during home oximetry monitoring versus those without desaturations. Our study shows that the majority of infants with mild bronchiolitis experience desaturations after discharge home. (more…)
Author Interviews, OBGYNE, Pediatrics, Pulmonary Disease, Tobacco Research / 24.02.2016

MedicalResearch.com Interview with: Dr. med. Julia Dratva, MD MPH          Medical Specialist Prevention and Public Health FMH  Scientific project leader MAS Versicherungsmedizin/Studienkoordinationleitung Dept. Epidemiology and Public Health Swiss Tropical and Public Health Institute Socinstrasse 57, P.O. Box, 4002 Basel, Switzerland Medical Research: What is the background for this study? What are the main findings? Dr. Dratva: Early childhood is a critical time window for subsequent health. Early life environment is known to be important for lung development and respiratory health. Little is known on the potential impact on lung ageing and the potential mechanisms responsible for the long-term impact. We investigated early childhood factors and their association with lung function decline, a common marker of lung aging, in two long-standing adult cohorts, SAPALDIA and ECRHS. As recently published in scientific journal PlosONE, maternal smoking, early respiratory infections or season of birth are associated with a faster decline in lung function decline, while less rapid decline was found in persons who had attended daycare. The early exposures may not only have an independent adverse effect on lung aging but also increase the respiratory vulnerability to other adult risk factors. Stronger effects were observed in in smokers exposed to the aforementioned adverse factors. (more…)
Author Interviews, Imperial College, Pulmonary Disease, Toxin Research / 23.02.2016

MedicalResearch.com Interview with: Dr Rebecca Ghosh, Research Associate  Small Area Health Statistics Unit (SAHSU) MRC-PHE Centre for Environment and Health Imperial College London St Mary's Campus, Norfolk Place, London  Medical Research: What is the background for this study? What are the main findings? Dr. Ghosh: Since the 1950s a lot of evidence has accumulated that high levels of air pollution cause harmful effects on health.  However there is limited evidence on the very long term (>25 years) effects of air pollution.  Our study is one of the longest running to date looking at air pollution and mortality, following 368,000 people in England and Wales for 38 years.  We estimated air pollution exposures throughout England & Wales for 1971, 1981, 1991 and 2001 using data from historic air pollution monitoring networks, the first time this has been done. We found that air pollution exposure in 1971 was still associated with a small increased risk of death in 2002-9, over 30 years later, suggesting that harmful effects of air pollution are extremely long-lasting.  However, risks from an individual’s past exposures waned over time and their more recent exposures gave the highest mortality risks. (more…)
Anesthesiology, Author Interviews, Critical Care - Intensive Care - ICUs, JAMA, Pulmonary Disease / 22.02.2016

MedicalResearch.com Interview with: John G. Laffey MD Chief, Department of Anesthesia; Co-Director, Critical illness and Injury Research Centre; Scientist, Keenan Research Centre for Biomedical Science ‑ St. Michael's Hospital Professor, Anesthesia, Critical Care, and Physiology ‑ University of Toronto Medical Research: What is the background for this study? Dr. Laffey: Acute respiratory distress syndrome is the commonest cause of severe acute respiratory failure in the critically ill. ARDS is a major cause of death and disability in the critically ill worldwide. Second, there is no treatment for ARDS, and our present management approaches are limited to supporting organ function while treating the underlying causes We performed the LUNG SAFE study to address several clinically important questions regarding ARDS. First, the current incidence in a large international cohort was not known. Large regional differences had been suggested: for example, the incidence of ARDS in the US was reported to be ten times greater of that in Europe_ENREF_4. Second, we wanted to understand how we manage patients with  Acute respiratory distress syndrome in the ‘real world’ situation. Specifically, it was not clear to what extent newer approaches to artificial ventilation, such as reducing the size of the breaths (lower tidal volumes) and keeping the lung pressure positive at all times to minimize collapse (PEEP) were used. The impact of studies showing promise for other measures to improve gas exchange such as turning patients prone during mechanical ventilation, or using neuromuscular blockade, on routine clinical practice in the broader international context was not known. Third, there were some concerns over the extent of clinician recognition of ARDS. This was an important issue because implementation of the effective therapies may be limited by lack of recognition of ARDS by clinicians. A better understanding the factors associated with ARDS recognition and how this recognition influenced patient management could lead to effective interventions to improve care. Lastly we wanted to determine the outcome from  Acute respiratory distress syndrome in a global cohort of patients. Medical Research: What are the main findings? Dr. Laffey: We found that ARDS continues to represent an important public health problem globally, with 10% of ICU patients meeting clinical criteria for ARDS. While there appeared to be some geographic variation, this did not seem as great as previously thought. An important finding was the under-recognition of  Acute respiratory distress syndrome by clinicians, with 40% of all cases not being recognized. In addition, over one third of patients did not receive protective lung ventilation strategies. The use of other measures to aid gas exchange during artificial ventilation, such as turning the patient into the prone position, or the use of neuromuscular blockade was also quite low. Of most concern, ARDS continues to have a very high mortality of approximately 40% of patients dying in hospital. (more…)
Allergies, Asthma, Author Interviews, JAMA, Pediatrics, Pulmonary Disease / 09.02.2016

MedicalResearch.com Interview with: Dr. Meghan B. Azad PhD Assistant Professor Department of Pediatrics & Child Health and Community Health Sciences University of Manitoba and Children’s Hospital Research Institute of Manitoba Associate Investigator, Canadian Healthy Infant Longitudinal Development (CHILD) Study Medical Research: What is the background for this study? Dr. Azad: Asthma is the most common reason for children to miss school or be admitted to hospital, and accounts for over 30% of Canadian healthcare billings for children. Although many treatments exist to manage asthma symptoms, it is a lifelong disease and there is no cure.  Prevention is the best approach to reduce the global burden of asthma, and our study provides important new information to inform asthma prevention strategies.   Medical Research: What are the main findings? Dr. Azad: Wheezing is common in babies and young children.  Our study looked at the long-term implications of wheezing in early life, using data from the Canadian Asthma Primary Prevention Study (CAPPS). We followed 320 children from Winnipeg and Vancouver from before birth until adolescence, and found that specific patterns of early wheezing (from age 0 to 7) were associated with decreased lung function and increased risk for asthma by age 15. By age 15, children who wheezed consistently through infancy and early childhood had the worst lung function (9% lower compared to non-wheezers) and the highest asthma risk (11 times higher). Even children with “transient early wheeze” (those who wheezed as babies but not as young children) had reduced lung function (5% lower) and increased asthma risk (4 times higher) as teenagers. (more…)
Author Interviews, Frailty, Mayo Clinic, Pulmonary Disease, Transplantation / 23.12.2015

MedicalResearch.com Interview with: Cassie Kennedy, M.D. Pulmonology and Critical Care Medicine Mayo Clinic  Medical Research: What is the background for this study? Dr. Kennedy: Lung transplant is a surgical procedure that can offer extended life expectancy and improved quality of life to selected patients with end-stage lung disease. However there are about 1700 patients awaiting lung transplant at any given time in the United States because transplant recipients far exceed potential donors.  In addition, even with carefully chosen candidates, lung transplant recipients live on average about 5.5 years.  It is therefore very important for transplant physicians to choose patients who will receive the most benefit from their lung transplant. Frailty (defined as an increased vulnerability to adverse health outcomes) has typically been a subjective consideration by transplant physicians when choosing lung transplant candidates.  The emergence of more objective and reproducible frailty measures from the geriatric literature present an opportunity to study the prevalence of frailty in lung transplant (despite that subjective screening) and to determine whether the presence of frailty has any impact on patient outcomes. Medical Research: What are the main findings? Dr. Kennedy: Frailty is quite common --46 percent of our patient cohort was frail by the Frailty Deficit Index. We also saw a significant association between frailty and worsened survival following lung transplantation: one-year survival rate for frail patients was 71.7 percent, compared to 92.9 percent for patients who were not frail. At three years this difference in survival persisted--the survival rate for frail patients was 41.3 percent, compared to 66.1 percent for patients who were not frail. (more…)
Author Interviews, Flu - Influenza, Pharmacology, Pulmonary Disease / 09.12.2015

MedicalResearch.com Interview with: Dr. Irene Braithwaite Deputy Director Medical Research Institute of New Zealand Wellington NZ Medical Research: What is the background for this study? What are the main findings? Dr. Braithwaite: We know from animal models that the reduction of fever is associated with an increased risk of dying from influenza. We also know that some influenza viruses cannot replicate well in the human febrile range (38 to 40 Celsius). Yet, guidelines on the management of community acquired influenza infection in humans is to rest, maintain hydration and to take antipyretics such as paracetamol on the basis that this may help and is unlikely to cause harm. We undertook this study to see whether using regular paracetamol during influenza infection might be harmful, as it may allow the influenza virus to replicate more readily, and increase and/or prolong symptoms. To the best of our knowledge, this is the first randomised controlled trial comparing the effects of regular paracetamol (1gram four times daily for five days) versus placebo in human adults infected with influenza. We found that there was no difference in influenza viral loads, temperature or influenza symptoms between the regular paracetamol group and placebo group. (more…)
Author Interviews, Pharmacology, Pulmonary Disease / 23.11.2015

MedicalResearch.com Interview with: Imre Noth, M.D. Professor of Medicine and Director of the Interstitial Lung Disease Programme The University of Chicago Medical Research: What is the background for this study? What are the main findings? Dr. Noth: In 2014, OFEV® (nintedanib) became one of the first FDA-approved drug treatments for idiopathic pulmonary fibrosis (IPF), a rare and serious lung disease that causes permanent scarring of the lungs. In this post-marketing surveillance study in the United States, treatment with OFEV in the real-world clinical setting showed a safety profile consistent with that observed in clinical trials supporting its approval by the FDA. Post-marketing surveillance of the safety and tolerability of OFEV in the United States has been collected in the Boehringer Ingelheim drug safety and reporting database since OFEV was first approved on October 15, 2014. Until May 31, 2015, 3,838 people were treated with OFEV for a length of time ranging from 14 to 265 days (on average 88 days).  The most frequently reported side effects were gastrointestinal in nature and included diarrhea, nausea, vomiting and decreased appetite. Diarrhea was the most frequently reported individual side effect, occurring at a similar frequency to that observed in the clinical trials supporting approval. No new safety concerns were identified. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Genetic Research, Pulmonary Disease / 20.11.2015

MedicalResearch.com Interview with: Dragana Vidovic and Marianne Carlon Laboratory for Molecular Virology and Gene Therapy KU Leuven, Belgium Medical Research: What is the background for this study? What are the main findings? Response: Cystic fibrosis (CF) or mucoviscidosis is a genetic disorder caused by mutations in the CFTR gene which codes for a chloride/bicarbonate channel that regulates fluid secretion across the epithelium in different organs, for instance, the airways and the gastrointestinal tract. In the cells of CF patients, these anion channels are dysfunctional or even absent leading to the formation of sticky mucus. Persistent airway infection is the major clinical manifestation. The symptoms can be treated, but there is no cure for the disorder. Gene therapy holds promise to cure the disease. Previous studies suggested that the treatment is safe, but largely ineffective for Cystic fibrosis patients. However, as gene therapy has recently proven successful for inherited disorders such as haemophilia and congenital blindness, we wanted to re-examine its potential for CF. Here we developed an improved gene therapy treatment based on inserting the CFTR gene into the genome of a recombinant AAV viral vector (rAAV), which is derived from the relatively innocent AAV virus. We used this vector to “smuggle” a healthy copy of the CFTR gene into the affected cells. We administered rAAV to CF mice via their airways. Most of the mice recovered. In patient-derived intestinal cell cultures or organoids, chloride and fluid transport was restored. Medical Research: What does the study add to the field? Response: Development of Cystic fibrosis gene therapy requires a thorough preclinical examination of a candidate vector in relevant cell and animal models before being administered to humans. Here, both in mice with Cystic fibrosis and in mini-guts or intestinal organoids derived from Cystic fibrosis patients, this approach yielded positive results setting the stage for further validation in large animal models which mimic the CF patient situation more faithfully. We believe that our study will revive the interest in CF gene therapy as a promising, mutation-independent approach to ultimately cure Cystic fibrosis. (more…)
Anesthesiology, Author Interviews, CHEST, Critical Care - Intensive Care - ICUs, PTSD, Pulmonary Disease / 24.10.2015

MedicalResearch.com Interview with: Jad Kebbe, MD Jacobs School of Medicine and Biomedical Sciences Department of Medicine University of Buffalo Medical Research: What is the background for this study? What are the main findings? Dr. Kebbe: This study proceeded after sensing that post-traumatic stress disorder (PTSD) was a major contributor to ill outcomes in Veterans who are hospitalized in general, and mechanically ventilated in the intensive care unit (ICU) in particular. There is plenty of data depicting the comorbid roles PTSD plays in other medical conditions, leading to an increase in the use of medical services. Furthermore, PTSD affects a Veteran’s adherence to both medical and psychiatric therapies. Having said this, the ICU course could itself negatively affect a pre-existing PTSD, or even lead to the inception of such a condition de novo. However, to date, there has been no study looking at the effect a pre-existing PTSD diagnosis may have on the ICU hospitalization and thereafter. Our study confirmed that PTSD led to an increase in sedative requirements (opiates and benzodiazepines) for Veterans who were mechanically ventilated for more than 24h between 2003 and 2013, and revealed a trend towards an increase in mortality when compared to Veterans not suffering from PTSD. This is why many veterans are trying to claim disability benefits using va benefits and disability lawyer Tennessee to help them fight their case. (more…)
Author Interviews, Beth Israel Deaconess, CHEST, Education, Pulmonary Disease / 23.10.2015

MedicalResearch.com Interview with: Dr. George Cheng MD Beth Israel Deaconess Medical Center  Medical Research: What is the background for this study? What are the main findings? Dr. Cheng: Since the introduction of flexible bronchoscope in late 1960s, flexible bronchoscopy has gained wide popularity and with over 500,000 procedures being performed in the USA annually.  Bronchoscopy training has been undergoing rapid advancement in recent years.  Virtual bronchoscopy, either web-based training or VR bronchoscopic simulators, were used to teach and to improve performance in bronchoscopy.  However, virtual reality simulators often cost over $100,000 dollars.  Given the prohibitive high cost, recent CHEST expert panel recommended that high fidelity simulators be offered only in regional simulation centers.  Therefore, low cost realistic bronchoscopy training models are an area of need. Recent development in 3D printing and 3D medical modeling has allowed clinicians to utilize CT scans to create physical models.  This approach can be used to create affordable 3D printed, anatomically accurate bronchoscopy training models.  However, the 3D printed tracheobronchial model has never been evaluated as a bronchoscopy simulation tool.  We aimed to address this question with our study. The 3D printed bronchoscopy model was generated from flexible nylon material and stained to match the airway mucosa coloration.  Participants of varies training levels performed bronchoscopy on both standard and 3D printed bronchoscopy model, graded each on a sliding scale from 0-100.  Overall, clinicians preferred the 3D printed model regardless of their level of training. (more…)