Allergies, Asthma, Author Interviews, JAMA, Pediatrics, Pulmonary Disease / 09.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21421" align="alignleft" width="180"]Dr. Meghan B. Azad PhD Assistant Professor Department of Pediatrics & Child Health and Community Health Sciences University of Manitoba Associate Investigator, Canadian Healthy Infant Longitudinal Development (CHILD Dr. Meghan Azad[/caption] 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.
Author Interviews, Frailty, Mayo Clinic, Pulmonary Disease, Transplantation / 23.12.2015

[caption id="attachment_20197" align="alignleft" width="125"]Cassie Kennedy, M.D. Pulmonology and Critical Care Medicine Mayo Clinic Dr. Cassie Kennedy[/caption] 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.
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.
Author Interviews, Pharmacology, Pulmonary Disease / 23.11.2015

[caption id="attachment_19554" align="alignleft" width="175"]Imre Noth, M.D. Professor of Medicine and Director of the Interstitial Lung Disease Programme The University of Chicago Imre Noth, M.D.[/caption] 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.
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.
Anesthesiology, Author Interviews, CHEST, Critical Care - Intensive Care - ICUs, PTSD, Pulmonary Disease / 24.10.2015

[caption id="attachment_18766" align="alignleft" width="200"]Jad Kebbe, MD Jacobs School of Medicine and Biomedical Sciences Department of Medicine University of Buffalo Dr. Jad Kebbe[/caption] 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.
Author Interviews, Beth Israel Deaconess, CHEST, Education, Pulmonary Disease / 23.10.2015

[caption id="attachment_18711" align="alignleft" width="116"]Dr. George Cheng MD Beth Israel Deaconess Medical Center Dr. George Cheng[/caption] 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.
Author Interviews, Pulmonary Disease / 12.10.2015

[caption id="attachment_18335" align="alignleft" width="125"]Eric Stephen White MD Associate Professor of Medicine and Director of Translational Interstitial Lung Disease Research, Pulmonary and Critical Care Medicine University of Michigan Health System Dr. Eric White[/caption] MedicalResearch.com Interview with: Eric Stephen White MD Associate Professor of Medicine and Director of Translational Interstitial Lung Disease Research, Pulmonary and Critical Care Medicine University of Michigan Health System Medical Research: What is the background for this study? What are the main findings? Dr. White: The data presented at the European Respiratory Society (ERS) International Congress 2015 provide additional insights into OFEV® (nintedanib), including safety and efficacy over approximately two years. The results show no relevant changes in the safety and tolerability of OFEV. The results also suggest that treatment has a long-term effect (approximately two years) on slowing disease progression across both pivotal and open-label trials (as measured by annual rate of forced vital capacity [FVC] decline). This ongoing study, INPULSIS™-ON, which is an open-label extension trial, is important because Idiopathic Pulmonary Fibrosis (IPF) is a progressive disease that may require ongoing treatment.
Author Interviews, Critical Care - Intensive Care - ICUs, JAMA, Pulmonary Disease, University of Michigan / 23.09.2015

Thomas Valley, MD Fellow, Division of Pulmonary and Critical Care University of Michigan Ann Arbor, MIMedicalResearch.com Interview with: Thomas Valley, MD Fellow, Division of Pulmonary and Critical Care University of Michigan Ann Arbor, MI Medical Research: What is the background for this study? What are the main findings? Dr. Valley: There has been dramatic growth in intensive care unit (ICU) use over the past 30 years. As the reasons for this growth are not entirely clear, some have suggested that the ICU is a meaningful source of low-value care. The value of the ICU, however, depends on the net benefit that ICUs provide patients. Prior observational studies assessing the effectiveness of the ICU were limited because patients admitted to the ICU are inherently sicker and more likely to die than patients admitted to the general ward. Given the substantial number of patients with pneumonia who are admitted to an ICU, it is vital to understand whether admission to the ICU is beneficial. In our study of 1.1 million Medicare beneficiaries with pneumonia between 2010 and 2012, we used an instrumental variable, a statistical technique to pseudo-randomize patients based on their proximity to a hospital that uses the ICU frequently for pneumonia, in order to determine whether ICU admission saved lives and at what financial cost. An estimated 13 percent of patients were admitted to the ICU solely because they lived closest to a hospital that used the ICU frequently for pneumonia. Among these patients, ICU admission was associated with a nearly six percent reduction in 30-day mortality compared to general ward admission. In addition, there were no significant differences in hospital costs or Medicare reimbursement between patients admitted to the ICU and to the general ward.
Author Interviews, CHEST, Occupational Health, Pulmonary Disease / 08.09.2015

MedicalResearch.com Interview with: Metin Akgun, MD, FCCP Department of Pulmonary Medicine Atatürk University, Faculty of Medicine Erzurum, Turkey Medical Research: What is the background for this study? What are the main findings? Dr. Akgun: The first cases of silicosis due to denim sandblasting were reported in 2005. In 2007, we evaluated 145 former male denim sandblasters who had an exposure history to at least 1 month with a latency period at least ten months; 77 (53%) were diagnosed as silicosis according to the profusion category of opacities of 1/0 or greater. In this study, we reported 4-year follow-up results of this cohort. Out of 83 sandblasters who were evaluated in this follow-up study, nine died and of the remaining 74, 96% had radiographic evidence of silicosis based on the same criteria and 66% had pulmonary function loss, which was defined as at least 12% or more decrease on FVC, predicted.
Allergies, Asthma, Author Interviews, Microbiome, Pulmonary Disease / 28.08.2015

Rebecca Normansell MA MB BChir Cochrane Airways Population Health Research Institute St George’s, University of London MedicalResearch.com Interview with: Rebecca Normansell MA MB BChir Cochrane Airways Population Health Research Institute St George’s, University of London     Medical Research: What is the background for this study? Response: Asthma is a common, long-term, respiratory condition which affects over 300 million people worldwide. It is a burden not only for the individual with asthma but also for the health services that care for them and the wider economy, due to days lost from work and school. Asthma therapies aim to prevent attacks and improve symptoms by reducing airway constriction and inflammation, but they come with their own risks of side effects. For example, long-term high-dose inhaled corticosteroids have been associated with growth restriction in children and long-acting beta2-agonists as mono-therapy have been associated with increased risk of death in people with asthma. There is growing interest in developing novel treatments for asthma and one such treatment is specific allergen immunotherapy. Immunotherapy has the potential to be a useful approach for asthma as it is thought that for approximately half of people with asthma, allergies are an important trigger for their symptoms and attacks. Immunotherapy can be delivered by injection (subcutaneously) or under the tongue (sublingually) and aims to bring about immune tolerance. Immunotherapy has already been demonstrated to be effective in certain conditions, such as allergic rhinitis and wasp and bee sting allergy, but its effectiveness and safety in asthma is less clear. In fact, immunotherapy is not recommended at all for use in people with severe or uncontrolled asthma due to the risk of triggering a serious respiratory reaction. Medical Research: What are the main findings? Response: Our review looked for trials in which people with asthma who were given sublingual immunotherapy (SLIT) were compared with those given placebo, or who continued usual asthma care. We found 52 randomised controlled trials which met our inclusion criteria, allocating over 5,000 people to either SLIT or placebo/usual care. Most of the participants had mild asthma and were allergic to either house dust mite or pollen. Despite the large number of eligible trials we were only able to perform a limited meta-analysis. This is because most of the trials did not report the efficacy outcomes we were most interested in: exacerbations and quality of life. Asthma symptoms and medication use were both more frequently reported, but often using different, un-validated scales so we did not perform a meta-analysis for these outcomes. However, we were able to combine serious adverse event data from 22 trials involving 2560 participants and data for all adverse events from 19 trials including 1755 participants. SLIT did not appear to be associated with an increased risk of serious adverse events, although very few events were observed overall. SLIT was associated with a small increase in the risk of all adverse events, which in absolute terms equated to an increase from 222 per 1000 people in the control group to 327 per 1000 (95% confidence intervals 257 to 404). Importantly, many of these events were mild and transient local reactions and did not generally result in participants withdrawing from the trial.
Author Interviews, Biomarkers, Dermatology, JAMA, Pulmonary Disease, University of Pennsylvania / 12.08.2015

Misha A. Rosenbach, MD Assistant Professor of Dermatology at the Hospital of the University of Pennsylvania Assistant Professor of Dermatology in MedicineMedicalResearch.com Interview with: Misha A. Rosenbach, MD Assistant Professor of Dermatology at the Hospital of the University of Pennsylvania Assistant Professor of Dermatology in Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Rosenbach: Sarcoidosis is an inflammatory disease of unknown etiology where genetically susceptible patients develop multi-organ granulomatous inflammation in response to an as-yet unidentified stimulus.  Patients with sarcoidosis typically have granulomatous inflammation in their lungs, but the second most commonly affected organ is the skin; the eyes, lymph nodes, liver, heart, brain, and other organs can be affected as well.  Patients with sarcoidosis can experience a few disease trajectories; some spontaneously recover, while others have persistent, active inflammation, whereas another group can experience inflammation which leads to scarring and fibrosis.  It can be challenging to distinguish these cohorts of patients based on their lungs alone. The skin is much easier to evaluate, as it is right there on the surface, and can be examined by physicians without resorting to invasive tests or radiography.  At Penn, we developed a novel cutaneous sarcoidosis assessment tool, called the Cutaneous Sarcoidosis Activity and Morphology Instrument (CSAMI), which is designed to accurately measure how inflamed skin sarcoid lesions are in a given patient, as well as describing which type of cutaneous lesion patients’ have.  The CSAMI has in previously studies been shown to be reliable when used by dermatologists, with excellent inter-rater and intra-rater reproducibility. In this study, we had a group of Pulmonologists, Rheumatologists, and Dermatologists (representing the groups of physicians who most commonly care for patients with sarcoidosis, especially if there is skin involvement) evaluate a group of patients with cutaneous sarcoidosis, using the CSAMI and another sarcoidosis activity instrument, the SASI, which has also previously been used to measure skin sarcoidosis activity in a number of settings.  We were able to demonstrate that these cutaneous scoring tools are reliable and reproducible and able to accurately measure cutaneous sarcoidosis disease activity in a variety of patients with a range of skin disease severity.  We also compared the physician scores to patients’ own evaluations of their disease, and showed that the CSAMI (physician impression of disease) correlated well with patients’ own perception of their disease activity and severity.
Author Interviews, Pulmonary Disease / 07.08.2015

MedicalResearch.com Interview with: Matthew D. Krasowski MD, PhD Department of Pathology University of Iowa, Iowa City, and Jonathan Genzen, MD, PhD Department of Pathology University of Utah, Salt Lake City, UT Medical Research: What is the background for this study? What are the main findings? Response: Serum angiotensin converting enzyme (ACE) activity is commonly measured for the diagnosis and management of sarcoidosis. It was well known several decades ago that serum ACE activity is reduced in patients taking ACE inhibitors (e.g., captopril, enalapril, lisinopril, etc.). However, providers ordering ACE levels may be unaware of this interaction and not realize that ACE inhibitor therapy can dramatically lower serum ACE activity (and thus resulting in a misleadingly low ACE level). The main goal of the study was to determine how often serum ACE levels were performed in patients prescribed ACE inhibitors. Using electronic medical record review at an academic medical center, it was determined that 8.4% of serum ACE levels were ordered on patients currently on ACE inhibitors. The group of patients on ACE inhibitors had significantly lower serum ACE activity than the other patients. Analysis of samples at a national reference laboratory arrived at a similar estimate. This analysis included detection of lisinopril in a subset of serum samples with very low ACE activity. At the academic medical center, the use of targeted warning prompts and alerts greatly reduced the frequency of ordering serum ACE activity in patients on ACE inhibitors.
Author Interviews, Heart Disease, JAMA, Pulmonary Disease, Surgical Research / 12.06.2015

Louise Sun, MD SM FRCPC Assistant Professor Department of Anesthesiology, University of Ottawa Staff | Division of Cardiac Anesthesiology University of Ottawa Heart InstituteMedicalResearch.com Interview with: Louise Sun, MD SM FRCPC Assistant Professor Department of Anesthesiology, University of Ottawa Staff | Division of Cardiac Anesthesiology University of Ottawa Heart Institute Medical Research: What is the background for this study? What are the main findings? Dr. Sun: Preoperative testing provides important information for perioperative planning and decision-making. However, given the rapid increase in health care costs, there has been growing emphasis on the more rational use of resources and thus the need to better understand the utilization patterns of specific tests. Preoperative pulmonary function tests (PFTs) are important in helping perioperative physicians identify patients at risk for postoperative pulmonary complications, but few appropriate use guidelines exist for this test. We conducted a population-based study using linked administrative databases in Ontario, Canada to describe temporal trends in preoperative pulmonary function tests and assess whether the recent 2006 American College of Physicians (ACP) guidelines on risk assessment and prevention of postoperative pulmonary complications for non-cardiothoracic surgery influenced these trends. We examined 511,625 individuals undergoing non-cardiothoracic surgery, amongst whom 3.6% underwent preoperative pulmonary function tests while 3.3% had non-operative PFTs. Preoperative pulmonary function tests rates decreased over the study period and following the 2006 ACP guidelines while non-operative rates remained stable. By 2013, preoperative pulmonary function tests were performed in fewer than 8% of Ontario patients with risk factors for pulmonary complications, while preoperative testing rates among individuals without known respiratory disease had approached rates seen in the non-operative setting. The decreasing preoperative pulmonary function tests rates contrast starkly against concurrent increases in rates of other perioperative interventions such as preoperative anesthesia consultations and stress testing.
Author Interviews, Infections, Pulmonary Disease / 05.06.2015

Dr. Nelson Lee MBBS(HK),MD(CUHK),FRCP(Lond),FRCP(Edin),FHKCP,FHKAM(Med) Daniel Yu Professor of Infectious Diseases Head, Division of Infectious Diseases, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong. Hon. Consultant, Prince of Wales Hospital, Hong KongMedicalResearch.com Interview with: Dr. Nelson Lee BBS(HK),MD(CUHK),FRCP(Lond),FRCP(Edin),FHKCP,FHKAM(Med) Daniel Yu Professor of Infectious Diseases Head, Division of Infectious Diseases, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong. Hon. Consultant, Prince of Wales Hospital, Hong Kong Medical Research: What is the background for this study? What are the main findings? Dr. Lee: Respiratory syncytial virus (RSV) is increasingly recognized as an important cause of severe respiratory-tract infections in older adults, resulting in excessive hospitalizations and deaths annually. At present, no established antiviral treatment is available. The slow progress in therapeutics development is limited by the poor understanding of the clinical manifestations, severity, virologic changes, and pathophysiology in adult RSV diseases. To address the knowledge gap, we conducted a prospective study to look at the lower-respiratory complications, progression to respiratory failure, and their relationships to genomic viral loads in adults hospitalized for confirmed RSV infections. We found that among 123 RSV patients, nearly 90% had lower respiratory tract complications (acute bronchitis/bronchiolitis, radiographic pneumonia, exacerbation of underlying airway diseases, or their combinations), 53% developed respiratory insufficiency requiring bronchodilators and supplemental oxygen, 16% required assisted ventilation, and 12% were admitted to ICU or died. High viral RNA concentration was detected in their respiratory samples, including in patients who had onset longer than 2 days (>7 log10copies/mL). Viral load was associated with disease severity and development of respiratory insufficiency (about 40% increase in risk per log RNA increase).
Author Interviews, Medical Imaging, Outcomes & Safety, Pulmonary Disease, Radiology / 29.05.2015

Evgeniya Sokolovskaya, DO, MD Monmouth Medical Center Long Branch, NJ 07740.MedicalResearch.com Interview with: Evgeniya Sokolovskaya, DO, MD Monmouth Medical Center Long Branch, NJ 07740. Medical Research: What is the background for this study? What are the main findings? Dr. Sokolovskaya: As the utilization of diagnostic imaging has continued to increase in recent years, the workload of radiologists has correspondingly risen. Radiologists are under pressure to increase productivity by increasing workload volume. Previous studies have shown that increasing the number of reporting exams per day can affect the accuracy of radiologic interpretations, increase an error rate and degrade radiologists’ performance in the detection of pathology as viewing time per study decreases. The purpose of this pilot study was to determine if faster reporting speed when reading CT imaging studies of the Abdomen and Pelvis, results in higher number of misses and interpretation errors. The results of our study showed that the number of major misses and interpretation errors significantly increased at the faster reporting speed.
Author Interviews, Pulmonary Disease / 30.03.2015

Gulshan Sharma, MD, MPH Division of Pulmonary Critical Care and Sleep Medicine University of Texas Medical Branch Galveston, TXMedicalResearch.com Interview with: Gulshan Sharma, MD, MPH Division of Pulmonary Critical Care and Sleep Medicine University of Texas Medical Branch Galveston, TX Medical Research: What is the background for this study? What are the main findings? Dr. Sharma: Thirty-five years ago, two multicenter trials reported substantial improvements in survival and quality of life with continuous oxygen therapy in the treatment of severe hypoxemia associated with chronic obstructive pulmonary disease (COPD). Notably, aside from smoking cessation, no other medical intervention therapy has been shown to improve survival for patients with COPD. It is estimated that upto a third of the patients who are prescribed oxygen continue to smoke. Using large claims data of Medicare beneficiaries with COPD, we found that patients with COPD who had a burn injury were more likely to have been prescribed oxygen therapy in the preceding 90 days compared to the control subjects. Patients with COPD on oxygen who had burn injury, the face, head and neck region were more commonly involved. In the U.S. oxygen is prescribed to an estimated one million Medicare beneficiaries, based on our estimates a physician would have to treat 1,421 patients with oxygen therapy for one year to cause one burn injury.
Author Interviews, Lung Cancer, Pulmonary Disease / 10.03.2015

Jean-Bosco Tagne Ph.D. Assistant Professor of Medicine Boston University School of Medicine; Pulmonary Center Boston, MA MedicalResearch.com Interview with: Jean-Bosco Tagne Ph.D. Assistant Professor of Medicine Boston University School of Medicine; Pulmonary Center Boston, MA Medical Research: What is the background for this study? What are the main findings? Response: The lung transcription factor Nkx2-1 is an important gene regulating lung formation, and normal respiratory functions after birth. Alteration in the expression of this transcription factor can lead to lung interstitial disease, postnatal respiratory distress and lung cancer. MicroRNAs repress gene expression, also controlling lung cell differentiation. In this study, we characterized miRNAs regulated by Nkx2-1 in lung cells by genome-wide analysis and confirm the expression patterns of highly regulated miRNAs in normal lung and in lungs lacking functional Nkx2-1. By in vitro studies in lung cell lines we found that down-regulation of Nkx2-1 de-represses miR-200c. Increased miR-200c, in turn, reduces the expression of its predicted targets Nfib and Myb. These findings add new components to the gene regulatory network controlled by Nkx2-1 in lung epithelial cells that may have implications in the various roles of Nkx2-1 in development and disease particularly in this case lung cancer where the levels are seriously altered.
Author Interviews, BMJ, Nutrition, Pulmonary Disease / 05.02.2015

MedicalResearch.com Interview with: Raphaëlle Varraso INSERM U1168, VIMA (Aging and chronic diseases. Epidemiological and public health approaches), 16 avenue Paul Vaillant Couturier Villejuif, France MedicalResearch: What is the background for this study? What are the main findings? Response: Respiratory health and lung function, strongly predict general health status and all-cause mortality. Chronic obstructive pulmonary disease (COPD) is currently ranked the third leading cause of death worldwide. The predominant risk factor for COPD in the developed world is cigarette smoking, but up to one-third of COPD patients have never smoked, suggesting that other factors are involved. Besides smoking, relatively little attention has been paid to other modifiable risk factors that might decrease risk of developing COPD, including diet. The Alternate Healthy Eating Index (AHEI)-2010, a new measure of diet quality based on current scientific knowledge, has been linked to risk of major chronic diseases, such as cardiovascular disease, diabetes and cancer. However, the role of dietary scores on risk of COPD is unknown. We examined this issue among >120,000 US female and male health professionals (Nurses’ Health Study and Health Professionals Follow-up Study), and we reported that a high AHEI-2010 dietary score score (reflecting high intakes of whole grains, vegetables, fruit, polyunsaturated fatty acids, nuts and legumes, and long-chain omega-3 fats, a moderate intake of alcohol, and low intakes of red/processed meats, trans fat, sodium and sugar-sweetened beverages) was associated with a lower risk of COPD in both women and men. This novel finding supports the importance of diet in COPD pathogenesis.
Author Interviews, CHEST, Hospital Readmissions, Pulmonary Disease / 03.01.2015

Tina Shah, MD University of Chicago Medicine Department of Pulmonary and Critical Care University of ChicagoMedicalResearch.com Interview with: Tina Shah, MD University of Chicago Medicine Department of Pulmonary and Critical Care University of Chicago Medical Research: What is the background for this study? What are the main findings? Dr. Shah: The reason why we undertook this study is to better understand the Medicare COPD population that falls under the purview of the CMS Hospital Readmissions Reduction Program (HRRP). This program places up to a 3% penalty on all Medicare revenues for hospitals that take care of beneficiaries should a hospital exceed its “expected readmission rate.” Previously 30 day readmissions after index admissions for congestive heart failure, acute myocardial infarction and pneumonia fell subject to the HRRP. As of October 2014, COPD has been added to the list, despite minimal evidence to guide hospitals in how to curb COPD readmissions. The goal of this research was to provide an epidemiological background for this population and identify trends as a hypothesis generating first step to predict who is most likely to be readmitted and to identify targets for successful future interventions on this group. Our study population is unique in that we longitudinally look at about 1/2 of all Medicare admissions for COPD exacerbations, using the CMS guideline definition which is based on discharge ICD-9 codes. As described in previous literature, there is a large discrepancy between identification of COPD by provider versus coding algorithm, however since the Hospital Readmissions Reduction Program is based on discharge coding it is important to examine this particular group.
Author Interviews, Pulmonary Disease, Vitamin C / 14.12.2014

Harri Hemilä, MD PhD Department of Public Health University of Helsinki, POB 41 Helsinki, FinlandMedicalResearch.com Interview with: Harri Hemilä, MD PhD Department of Public Health University of Helsinki, POB 41 Helsinki, Finland   Medical Research: What is the background for this study? What are the main findings? Dr. Hemilä: I have a two decade interest in the effects of vitamin C on respiratory symptoms and I am the first author of the Cochrane review on vitamin C and the common cold. Since there is very strong evidence that vitamin C is better than placebo, in the Cochrane review we encourage common cold patients to try if vitamin C helps them. In 2009, I was taking a look at the Cochrane review on vitamin C and asthma. I was puzzled with the text and figures since my own impression of the RCTs on vitamin C and asthma was quite different from what the review presented. Therefore I took a close look at the Cochrane review and I saw that it was sloppy. There were severe errors in data extraction and data analysis. For example, they used un-paired t-test when they should have used the paired t-test. That types of questions are very basic in biostatistics. I wrote a feedback to that Cochrane review and the review was withdrawn in 2013. It had been misleading readers for a decade. As a positive result of that incident, I became interested in the effects of vitamin C on asthma and I conducted a meta-analysis of three RCTs on vitamin C and exercise-induced bronchoconstriction (EIB). I calculated that vitamin C caused a 48% reduction (95% CI 33% to 64%) in the postexercise FEV1 decline. That study was published in BMJ Open in 2013 (http://www.ncbi.nlm.nih.gov/pubmed/23794586).
Author Interviews, CHEST, Nutrition, Pulmonary Disease / 26.11.2014

Refaat Hegazi, MD, PhD, MS, MPH Medical Director, Abbott Nutrition Affiliate Research Associate Professor, The Brody School of Medicine at East Carolina UniversityMedicalResearch.com Interview with: Refaat Hegazi, MD, PhD, MS, MPH Medical Director, Abbott Nutrition Affiliate Research Associate Professor, The Brody School of Medicine at East Carolina University Medical Research: What is the background for this study? What are the main findings? Dr. Hegazi: This study stems from the need to address the financial and health burdens that Chronic Obstructive Pulmonary Disease (COPD) places on the United States. It is the third leading cause of death in the U.S. and costs us about $50 billion a year. It’s a devastating and chronic condition that plagues patients on a daily basis, and previous studies have shown that proper nutrition is essential for proper pulmonary function and rehabilitation. In a retrospective study of inpatient medical records, we found that by ensuring the nutritional needs of COPD patients were met with oral nutritional supplements (ONS), we were able to tackle the issue of cost, as well as better health outcomes. Specifically, the COPD patients that received oral nutritional supplements, experienced reduced length of hospitalization, lower average hospital costs, and lower readmission rates within 30 days, compared to those that did not.
Author Interviews, CDC, Pediatrics, Pulmonary Disease / 21.11.2014

MedicalResearch.com Interview with: Dr. Wanjun Cui, MS PhD Department of Health and Human Services, Centers for Disease Control and Prevention (CDC) Medical Research: What is the background for this study? What are the main findings? Authors’ response: Asthma is a leading chronic disease among adolescents that adversely affects their health. However, it is unclear how asthma influences their perceived health or health-related quality of life (HRQOL). Because their perceptions of their health may differ from those of their caregivers (such as parents or health professionals), knowing how adolescents with asthma would rate their own health is very important. Our study compares the responses of adolescents with and without asthma about different aspects of HRQOL including their overall health, their recent physical health, their recent mental health, and their recent activity limitations due to health. Unlike previous U.S. studies based on small clinical samples, our study used a nationally representative sample of U.S. adolescents that can be generalized to the whole U.S. adolescent population. We found that asthma is adversely associated with almost all these aspects of HRQOL but only among those with asthma and current symptoms such as wheezing and dry cough. Adolescents with asthma without current symptoms did not report significantly worse HRQOL than those without asthma. For example, compared with those who never had asthma, adolescents with asthma and symptoms of dry cough or wheezing reported significantly more fair or poor self-rated health (14% vs. 8%), 34% more recent physically unhealthy days , and 26% more recent mentally unhealthy days. More importantly, adolescents with asthma who currently smoked cigarettes or reported limited physical functioning reported even worse physical and mental HRQOL.
Author Interviews, Pulmonary Disease / 19.11.2014

Anne Stephenson MD, PhD Division of Respirology The Toronto Adult Cystic Fibrosis Centre St. Michael's Hospital Toronto, ON MedicalResearch.com Interview with: Anne Stephenson MD, PhD Division of Respirology The Toronto Adult Cystic Fibrosis Centre St. Michael's Hospital Toronto, ON Medical Research: What is the background for this study? What are the main findings? Dr. Stephenson: Cystic Fibrosis is progressive genetic disease that results in very thick secretions in various organs such as the lungs, pancreas, and digestive tract. Over time, these thick secretions damage organs in particular, the lungs, which results in respiratory failure due to recurrent chest infections. Cystic Fibrosis patients are also at high risk for malnutrition due to the inability to absorb food which is associated with poor survival. In the 1960s, people with Cystic Fibrosis died at a very young age and in fact, parents who had a child born with Cystic Fibrosis at that time were told that there was a 50% chance their child would not live to attend kindergarten. Over the last several decades, we have seen a significant increase in the survival of individuals with CF. Individuals born with Cystic Fibrosis today can expect to not only attend kindergarten, but complete high school, perhaps attend college or university, have a career, get married or have children as people are living well into adulthood with this disease. The median age of survival in Cystic Fibrosis today is approximately 50 years of age in Canada which is quite remarkable.
Author Interviews, Pulmonary Disease, Race/Ethnic Diversity / 23.10.2014

Nandita Bhan, ScD MSc MA Research Scientist & Adjunct Assistant Professor Public Health Foundation of India (PHFI)MedicalResearch.com Interview with: Nandita Bhan, ScD MSc MA Research Scientist & Adjunct Assistant Professor Public Health Foundation of India (PHFI) Medical Research: What are the main findings of the study? Dr. Bhan: We found that the last decade in the US has seen a rise in racial/ethnic disparities in asthma. Compared to Non-Hispanic White populations, greater rates of asthma were seen among African Americans and lower rates among Hispanic populations. But more importantly, we found that it is not just a question of who you are, but where you live. Results showed heterogeneity by region and place of origin - highlighting that it will be simplistic to assume that asthma rates for Hispanic populations are the same across all states in the US. While data is unable to explore further granularity by ethnicity, our results add to the developing evidence that state policies and politics have impacts on socioeconomic and racial/ethnic inequalities manifesting in health disparities in the US.
Author Interviews, Pulmonary Disease / 23.10.2014

MedicalResearch.com Interview with: Jared Radbel MD Staten Island, New York Medical Research: What are the main findings of the study? Dr. Radbel: Using ICD 9 coding from the largest all-payer inpatient health care database in the United States, the National Inpatient Sample (NIS) database we identified 174,180 patients with Acute Respiratory Distress Syndrome (ARDS) from 1996-2011.  When expanded to estimate country-wide discharges, our data represents 856,293 patients.  We found a decrease in case fatality rate from 46.8% in 1996 to 32.2% in 2011. This corresponds to an absolute mortality reduction of 14.6% and relative reduction of 31%.
Author Interviews, BMJ, Environmental Risks, OBGYNE, Pulmonary Disease / 22.10.2014

Medical Research Interview with: Eva Morales, MD, PhD, MPH Centre for Research in Environmental Epidemiology (CREAL) Barcelona Biomedical Research Park Barcelona, Spain Medical Research: What are the main findings of the study? Dr. Morales: We aimed to assess the consequences of exposure to outdoor air pollution during specific trimesters of pregnancy and postnatal lifetime periods on lung function in preschool children. We conducted a longitudinal study by using data from 620 mother-child pairs participating in the INfancia y Medio Ambiente (INMA) Project – a population-based cohort study set up in several geographic areas in Spain. We found that exposure to outdoor air pollution during the second trimester of pregnancy in particular raises the risk of harm to a child’s lung function at preschool age.
Author Interviews, JAMA, Pulmonary Disease, Toxin Research / 13.10.2014

Adam Spanier, MD, PhD, MPH, FAAP Associate Professor of Pediatrics Division Head, General Pediatrics & Developmental and Behavioral Pediatrics Medical Director, Pediatrics at Midtown Department of Pediatrics University of Maryland Midtown Campus Baltimore, MD 21201MedicalResearch.com Interview with: Adam Spanier, MD, PhD, MPH, FAAP Associate Professor of Pediatrics Division Head, General Pediatrics & Developmental and Behavioral Pediatrics Medical Director, Pediatrics at Midtown Department of Pediatrics University of Maryland Midtown Campus Baltimore, MD 21201 Medical Research: What are the main findings of the study? Dr. Spanier: Bisphenol A (BPA) is a chemical that is present in many consumer products (lining of canned foods, some plastics, some receipt paper, etc). We found that higher maternal Bisphenol A levels during pregnancy were associated with increased odds of persistent wheezing in children and a decrease in lung function at age four. Child BPA levels were not associated with these poor lung health outcomes.
Author Interviews, JAMA, Pulmonary Disease / 20.09.2014

Andrea Gershon MD, MSc, FRCP(C) Scientist, Institute for Clinical Evaluative Sciences Respirologist, Division of Respirology, Sunnybrook Health Sciences Centre Assistant Professor of Medicine, University of Toronto ICES Central Bayview Avenue, Toronto, OntarioMedicalResearch.com Interview with: Andrea Gershon MD, MSc, FRCP(C) Scientist, Institute for Clinical Evaluative Sciences Respirologist, Division of Respirology, Sunnybrook Health Sciences Centre Assistant Professor of Medicine, University of Toronto ICES Central Bayview Avenue, Toronto, Ontario Medical Research: What are the main findings of the study? Dr. Gershon: Within a large real world population of people with COPD, those who initiated combination long-acting beta-agonists (LABA) and inhaled corticosteroids (ICS) were less likely to die or be hospitalized for COPD than those who initiated LABA alone. Further those who initiated LABA/ICS combination therapy did not appear to have more pneumonia or osteoporotic fractures – side effects that have been associated with ICS use—than those initiating LABA alone. A second interesting finding was that people with a co-diagnosis of asthma experienced a greater incremental benefit of LABA/ICS over LABA than people without a co-diagnosis of asthma. Finally, we found that people who were not also taking an inhaled long-acting anticholinergic medication experienced a greater incremental benefit of LABA/ICS over LABA than people who were.
Author Interviews, JAMA, Pediatrics, Pulmonary Disease / 19.08.2014

Suzanne Schuh, MD, FRCP(C), FAAP, ABPEM Staff Paediatrician, Division of Paediatric Emergency Medicine Senior Associate Scientist, Research Institute, Hospital for Sick Children Professor of Paediatrics, University of TorontoMedicalResearch.com Interview with: Suzanne Schuh, MD, FRCP(C), FAAP, ABPEM Staff Paediatrician, Division of Paediatric Emergency Medicine Senior Associate Scientist, Research Institute, Hospital for Sick Children Professor of Paediatrics, University of Toronto Medical Research: What are the main findings of this study? Dr. Schuh: Our study shows that in previously healthy infants presenting to the Emergency Department with mild to moderate bronchiolitis (a viral lower respiratory tract disease producing breathing distress) who had their oxygen saturation measurements artificially elevated by a physiologically small amount experienced significantly reduced rate of hospitalizations within 72 hours compared to infants with unaltered oximetry readings.