Patients with severe emphysema can achieve considerably greater improvements in bone mineral density (BMD) by undergoing lung volume reduction surgery than from rehabilitation, according to a new study. Researchers in Rome, Italy selected, 70 male patients with severe emphysema, who were advised to undergo lung volume reduction surgery. Forty patients decided to undergo surgery, while the other 30 chose to participate, instead, in a standard respiratory rehabilitation program. Patients who underwent surgery experienced significant improvements in respiratory, symptomatic, anthropometric, and biochemical parameters, whereas patients in rehabilitation experienced a worsening of bone-related hormones and turnover markers without recovering bone mass. The most significant improvements in BMD were in the 19 patients who underwent surgery and quit oral steroids. The 21 other patients who underwent surgery but continued taking oral steroids also experienced improvements with BMD, but to a lesser degree. Researchers conclude that lung volume reduction surgery is better for improving BMD than rehabilitation, whether or not the patient continues taking oral steroids. The study appears in the June issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.
BMI DOES NOT PREDICT MICU OUTCOME
Patients who are obese are not at greater risk of morbidity, mortality, or increased costs in the Medical Intensive Care Unit (MICU), according to new findings. Researchers in Allentown, PA, recorded the height, weight, age, hospital length of stay, medical complications, and other variables of 813 patients admitted to the MICU between January 1997 and August 2001. The study subjects were divided into five groups: underweight (BMI less than 20.0), normal weight (BMI = 20.0-24.9), overweight (BMI = 25.0-29.9), obese (BMI = 30-39.9), and severely obese (BMI = 40.0 or more). No significant difference was found between the MICU length of stay, hospital length of stay, need for mechanical ventilation or number of days on the ventilator, mortality rate, and costs for obese and very obese patients when compared to the other three groups. The only significant difference found was that the patients who were severely obese were more likely to be female and younger than the obese patients. The study appears in the June issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.
REDUCED LUNG FUNCTION INCREASES CARDIOVASCULAR RISK
New research shows that reduced lung function is a strong predictor of cardiovascular morbidity and mortality and ischemic heart disease. In an analysis of 1,861 participants of the first National Health and Examination Survey Epidemiologic Follow-up Study, researchers from Canada found that people with the most reduced lung function (measured by FEV1) are at greatest risk for cardiovascular morbidity. These patients had five times the risk of ischemic heart disease when compared with patients having strong lung function. A literature review of 12 large cohort studies, which included 83,880 participants, supported the notion that those with reduced FEV1 were at higher risk of cardiovascular mortality. This association was found to be independent of smoking status, age, gender, and other factors. The study appears in the June issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.