Pulmonary Disease
17 Dec Does Skin Pigmentation Affect Accuracy of Pulse Oximetry in Infants?
MedicalResearch.com Interview with: [caption id="attachment_30505" align="alignleft" width="150"]
Dr. Elizabeth Foglia[/caption]
Elizabeth Foglia, MD MSCE
Assistant Professor of Pediatrics
University of Pennsylvania Perelman School of Medicine
Attending Neonatologist
Hospital of the University of Pennsylvania
The Children's Hospital of Philadelphia
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Pulse oximetry is a non-invasive method of monitoring oxygen saturation that is frequently used to monitor ill newborns and infants. Previous studies of adults with hypoxemia (low blood oxygen levels) demonstrated that pulse oximetry is less accurate in adults with dark skin, compared to adults with light skin. We sought to determine if skin pigment affects the accuracy of pulse oximetry in infants with hypoxemia.
We studied 2 widely used pulse oximeters, and we did not find evidence that skin pigment affects the accuracy of pulse oximetry in infants with hypoxemia.
However, the overall performance (combined accuracy and precision) of both oximeters was poor. In addition, one oximeter (the Nellcor Oximax) consistently overestimated the measured blood oxygen level.
15 Dec Interventions to Improve Rate of Successful Extubation in Preterm Infants
Posted at 13:08h
in Author Interviews, Critical Care - Intensive Care - ICUs, JAMA, Pediatrics, Pulmonary Disease
MedicalResearch.com Interview with:
Kristin N. Ferguson, BSc
The Royal Women’s Hospital and
Deakin University
Melbourne, Victoria, Australia
MedicalResearch.com: What is the background for this study?
Response: Weaning preterm infants from mechanical ventilation, thereby minimising the risks of having an endotracheal tube in situ which may further damage their fragile lungs, is something all neonatal clinicians are keen to do. We provide clinicians with a straightforward list of safe and effective strategies to help them in this task, as well as pointing out some treatments to either avoid or use with caution.
02 Dec Lung Maturity Test Can Determine Which Premature Infants are at risk of RDS
MedicalResearch.com Interview with: [caption id="attachment_30177" align="alignleft" width="164"]
Prof. Henrik Verder[/caption]
Prof. Henrik Verder
Department of Pediatrics
Holbaek University Hospital
Denmark
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Respiratory Distress Syndrome (RDS) is a major cause of mortality and morbidity in premature infants. It can be effectively treated with surfactant, a therapy which reduces the effort needed to expand the lungs during inspiration and allow gas exchange to take place. Early surfactant treatment can help prevent the onset and impact of RDS, however, prophylactic treatment has been shown to be harmful and only necessary in half of all pre-term infants. This study provided data validating the efficacy of a lung maturity test (LMT) in identifying infants at risk of respiratory distress syndrome (RDS) who could benefit from early surfactant treatment.
08 Nov Studies Reinforce Efficacy of Ofev in Idiopathic Pulmonary Fibrosis
MedicalResearch.com Interview with: [caption id="attachment_29484" align="alignleft" width="200"]
Dr. Luca Richeldi[/caption]
Dr. Luca Richeldi MD PhD
Professor of Respiratory Medicine
Chair of Interstitial Lung Disease
University of Southampton
United Kingdom
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The data presented at CHEST 2016 were from two post-hoc pooled analyses of the Phase III INPULSIS® trials that evaluated Ofev in idiopathic pulmonary fibrosis, or IPF. Both analyses, using different measures, demonstrate Ofev efficacy in a range of people with IPF, regardless of disease severity at the start of the trials.
One analyses investigated the efficacy of Ofev on disease progression in subgroups of patients defined by their GAP (gender, age, physiology) stage. Based on the index, patients were categorized as either GAP stage I or II/III. The analysis showed a similar reduction in disease progression with Ofev versus placebo regardless of GAP stage – meaning no significant difference between GAP stage I versus GAP stage II/III. Disease progression was defined as an absolute decline in forced vital capacity (FVC) ≥5% predicted or death over 52 weeks.
24 Oct Pulmonary Embolism May Be An Overlooked Cause of Syncope
MedicalResearch.com Interview with: [caption id="attachment_28937" align="alignleft" width="118"]
Dr.Paolo Prandoni[/caption]
Paolo Prandoni, M.D., Ph.D. and
Department of Cardiovascular Sciences
Vascular Medicine Unit
University of Padua, Padua
[caption id="attachment_28938" align="alignleft" width="82"]
Dr.Sofia Barbar[/caption]
Sofia Barbar, M.D
Department of Internal and Emergency Medicine
Civic Hospital of Camposampiero
Camposampiero
MedicalResearch.com: WhaWhat are the main findings?
Response: Syncope is defined as a sudden loss of consciousness due to transient global cerebral hypoperfusion characterized by rapid onset, short duration, and spontaneous complete recovery. According to the most recent guidelines, syncope can be classified as neurally-mediated, due to orthostatic hypotension and cardiovascular. Syncope is frequent in general population and represents up to 2% of all attendances in Emergency Department in Europe. The initial approach is unable to identify a plausible cause for syncope in 25-30% of cases and approximately 40% of syncope referred to an Emergency Department is then admitted to the hospital.
Pulmonary embolism (PE) is an obstruction in the pulmonary arteries interfering with both blood circulation and gas exchange and therefore representing a potentially life-threatening event. Clinical features of PE are extremely variable.
Available guidelines on syncope management consider PE as an infrequent cardiovascular cause of syncope. However, the true prevalence of pulmonary embolism in syncope-patients it is actually unknown. Moreover a workup for PE diagnosis in these patients is not suggested in the current guidelines.
07 Sep Real World Trial Show Efficacy of Fluticasone Furoate–Vilanterol for COPD in Clinical Practice
MedicalResearch.com Interview with: Jørgen Vestbo DMSc FRCP FERS Professor of Respiratory Medicine Division of Infection, Immunity and Respiratory Medicine University of Manchester Education and Research Centre University Hospital of South Manchester Manchester MedicalResearch.com: What is the background for this study? What are the main findings? Response: Efficacy studies are limited in their usefulness to clinicians as there are often restricted inclusion criteria, with many exclusion criteria and patients are followed closely with high adherence to study treatment. They therefore show what the drugs can do but not necessarily what they do do in the real world. Randomised studies in everyday practice, not limiting the entry (effectiveness trials) are therefore needed. In our study we showed that it is feasible to do randomised studies in the “real world”. Our study showed that a simple treatment with a once-daily combination of an inhaled corticosteroid and a long-acting beta-agonist (Breo/Relvar) was superior to the usual care chose by the patients’ general practitioners to manage their COPD.06 Sep Extubating Patients From Ventilators At Night Linked To Higher Mortality
MedicalResearch.com Interview with: [caption id="attachment_27671" align="alignleft" width="125"]
Dr. Hayley Gershengorn[/caption]
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.
11 Aug Study Raises Concerns About Sales of Secondhand CPAP Devices
Posted at 22:06h
in Author Interviews, JAMA, Obstructive Sleep Apnea, Pulmonary Disease, Sleep Disorders
MedicalResearch.com Interview with:
[caption id="attachment_26802" align="alignleft" width="150"]
Dr. Kunisaki[/caption]
Ken Kunisaki, MD, MS
Associate Professor of Medicine
Minneapolis Veterans Affairs Health Care System and University of Minnesota and
[caption id="attachment_26803" align="alignleft" width="98"]
Dr. Prichard[/caption]
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.
10 Aug Abnormal Microbiome Found in Preterm Infants Who Develop Chronic Lung Disease
[caption id="attachment_26871" align="alignleft" width="139"] Dr. Lal[/caption] MedicalResearch.com Interview with: Charitharth ‘Vivek' Lal, MD Assistant Professor, Division of Neonatal-Perinatal Medicine, Departments of Pediatrics University of Alabama at Birmingham Birmingham, AL 35249-7335 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Airway microbiome of neonates, at birth, has not been studied. Also, association of airway...
27 Jul Secondhand Pot Smoke Just As Bad For Heart As Tobacco
MedicalResearch.com Interview with: [caption id="attachment_26428" align="alignleft" width="200"]
Dr. Matthew Springer[/caption]
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.
20 Jul Nintedanib – Ofev – Slows Progression in Broader Group of Idiopathic Pulmonary Fibrosis Patients
MedicalResearch.com Interview with: [caption id="attachment_26335" align="alignleft" width="166"]
Dr. Ganesh Raghu[/caption]
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.
06 Jul Bronchoscopy Can Expose Health Care Workers To Pathogens in Aerosol
MedicalResearch.com Interview with: [caption id="attachment_25886" align="alignleft" width="149"]
Dr-Genevieve-Marchand[/caption]
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.
28 Jun Early Rehabilitation Did Not Shorten Hospital Stay For ICU Patients
Posted at 15:52h
in Author Interviews, Critical Care - Intensive Care - ICUs, JAMA, Pulmonary Disease
MedicalResearch.com Interview with:
[caption id="attachment_25567" align="alignleft" width="149"]
Dr. Peter Morris[/caption]
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.
12 Jun Marijuana Smoke Could Have Similar Effects on Lungs as Tobacco
MedicalResearch.com Interview with: [caption id="attachment_25149" align="alignleft" width="200"]
Dr. Stefania Papatheodorou[/caption]
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.
18 May Persistent Childhood Asthma Linked to Long-Term Lung Function Deficits
MedicalResearch.com Interview with: [caption id="attachment_24442" align="alignleft" width="106"]
Dr. James Kiley[/caption]
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.
15 May Children With Persistent Asthma At Risk For Future Lung Disease
Posted at 11:57h
in Asthma, Author Interviews, Brigham & Women's - Harvard, NEJM, Pediatrics, Pulmonary Disease
MedicalResearch.com Interview with:
[caption id="attachment_24191" align="alignleft" width="150"]
Dr. Michael McGeachie[/caption]
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.
25 Apr Eosinophil Count Identifies COPD Patients Who May Benefit From Inhaled Steroids
MedicalResearch.com Interview with: [caption id="attachment_23751" align="alignleft" width="200"]
Dr. Danny MvBryan[/caption]
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.
14 Apr Simple Blood Test To Identify COPD Patients Who Will Benefit from Inhaled Steroids
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.07 Apr Task Force Recommends Against Routine COPD Screening in Asymptomatic Adults
MedicalResearch.com Interview with: [caption id="attachment_23256" align="alignleft" width="117"]
Dr. William Phillips[/caption]
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.
05 Apr First Trimester Use of Rhinocort Linked To Respiratory Defects in Newborns
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).01 Apr New Study Does Not Support Antacids for All Patients With IPF
MedicalResearch.com Interview with: [caption id="attachment_23063" align="alignleft" width="133"]
Dr. Michael Kreuter[/caption]
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.
01 Apr Kinase Inhibitor Ofev Slows Progression of Idiopathic Pulmonary ibrosis
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.18 Mar New ThoraXS Device Rapidly Decompresses Pneumothorax
Posted at 12:56h
in Author Interviews, Critical Care - Intensive Care - ICUs, Pulmonary Disease, Surgical Research, Technology
MedicalResearch.com Interview with:
[caption id="attachment_22754" align="alignleft" width="133"]
Dr. Ariel Drori[/caption]
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.
15 Mar CPAP Benefits Sleep and Blood Pressure in Diabetics, But Not Glucose Control
MedicalResearch.com Interview with: [caption id="attachment_22702" align="alignleft" width="142"]
Dr. Jonathan Shaw[/caption]
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.
08 Mar Insufficient Evidence N95 Respirators Protect Health Care Workers From Respiratory Infections Better Than Face Masks
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.29 Feb Oxygen Saturation Poor Predictor of Return Visits For Infant Respiratory Infections
Posted at 16:41h
in Author Interviews, Emergency Care, Infections, JAMA, Pediatrics, Pulmonary Disease, Respiratory
MedicalResearch.com Interview with:
[caption id="attachment_22065" align="alignleft" width="150"]
Dr. Suzanne Schuh[/caption]
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.
24 Feb Being Born in Winter, or To A Smoker, Worsens Children’s Lung Health
MedicalResearch.com Interview with: [caption id="attachment_21974" align="alignleft" width="135"]
Dr. Julia Dratva[/caption]
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.
23 Feb Harmful Effects of Air Pollution Can Last Decades
MedicalResearch.com Interview with: [caption id="attachment_21406" align="alignleft" width="149"]
Dr. Rebecca Ghosh[/caption]
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.
22 Feb Acute Respiratory Distress Syndrome Often Underrecognized, Has High Mortality
Posted at 20:35h
in Anesthesiology, Author Interviews, Critical Care - Intensive Care - ICUs, JAMA, Pulmonary Disease
MedicalResearch.com Interview with:
[caption id="attachment_21841" align="alignleft" width="180"]
Dr. John Laffey[/caption]
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.