Researchers have shown that the subsequent 2 to 3 years after discharge from the hospital following treatment for pneumonia may provide only a short-term lease on a future healthy life if the patient has certain significant and independent predictors of mortality. Investigators ascertained the survival status of 366 community-acquired pneumonia patients who were hospitalized at Methodist Healthcare Memphis Hospital, Memphis, Tennessee. The investigators showed that increasing age, together with accompanying cardiovascular and cerebrovascular disease, presence of an altered mental state, and anemia were significant and independent predictors of mortality in the subsequent 2 to 3 years after hospital discharge for pneumonia. In their research, the investigators were able to ascertain the survival status of 97 percent of the patients over an average of 3 years after discharge. Death occurred in 125 patients after discharge from the hospital. In their study, they found no apparent excess medium-term mortality in the 18-40-year- old former pneumonia patients who had no other accompanying diseases. However, they did find a trend toward higher mortality in older age groups with no accompanying disease, especially in 41- 60-year-old age group. They said that, although the trend evidence was not statistically significant, it did not exclude the possibility that pneumonia might be a sentinel event for increased mortality in a subgroup of patients. In an editorial on the subject by Scott F. Dowell, M.D., a representative of the U.S. Centers for Disease Control and Prevention who is with the International Emerging Infections Program in Thailand, he wrote: (the researchers) "provide a useful contribution to a growing body of evidence indicating that patient hospitalization for pneumonia can expect a mortality rate that is modestly to substantially increased over the subsequent 1 to 4 years." Dr. Dowell urged physicians caring for pneumonia patients to issue standing hospital discharge orders that would call for current influenza vaccine and pneumococcal pneumonia vaccine, plus a smoking cessation program if needed, for all recovered pneumonia patients. The study and editorial appear in the second issue for April 2004 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.
IN-CAR AIR POLLLUTION EXPOSURE AFFECTS HEALTHY STATE TROOPERS
A study of tiny airborne particulate matter in the vehicles of nine healthy, young, non-smoking male North Carolina State Highway Patrol troopers as they each worked four 3 p.m. to midnight shifts showed that pollutants could cause pathophysiologic changes in the officers that involved inflammation, coagulation, and cardiac rhythms. The investigators pointed out that the troopers showed significant and strong increase in heart rate variability, ectopic heart beats, blood inflammatory and coagulation markers, and mean corpuscular volume in association with exposure to particulate matter. (Ectopic heart beats originate at some point other than the heart's "pacemaker"--the sinus node.) Each trooper's patrol car was equipped with an air quality monitor. Blood was drawn 14 hours after each shift, and ambulatory monitors recorded the electrocardiogram throughout the shift and until the next morning. The researchers said that the troopers represented a group that appeared to be at very low risk for cardiac and other adverse health conditions. However, they did point out that the study showed a strong and consistent increase in heart rate variability in association with exposure to airborne particulate matter. Also, there were inflammatory markers in the peripheral blood that suggested exposure causes slight vascular inflammation. The research appears in the second issue for April 2004 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.
REDUCED INFANT AIRWAY FUNCTION AND LATER WHEEZING
Reduced airway function measured when an infant was 1 month old has been associated with persistent wheeze in the child at age 11. The relationship proved to be independent of increased airway resistance and any allergy to which the child had an inherited tendency (atopy). The test took place in all infants before the onset of respiratory symptoms appeared. The research group assessed the pulmonary function of 243 infants 1 month after birth. At age 11, 185 members of the cohort were reassessed, and 55 (28 percent) were shown to have had wheeze "ever." According to the authors, reduced neonatal lung function was associated with wheezing at age 4 to 6 years that persisted to 11 years of age. The researchers said that recurrent childhood wheeze is common. It can begin in early life and may persist into later life. In some individuals, factors present in early life can be lifelong determinants of respiratory outcome. The investigators noted that elements associated with persistent childhood wheeze included male sex, and history of either maternal asthma or smoking. They point out that the mechanisms for the development of persistent childhood wheeze remain incompletely understood. They said that several prior studies had shown that similar test results on infants also demonstrated an increased risk for the development of bronchiolitis, pneumonia, and increased wheeze. The study appears in the second issue for April 2004 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.
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Journal
American Journal of Respiratory and Critical Care Medicine