ASTHMA
Asthma May Be Overdiagnosed in Obese Patients
(Monday, October 23, 2006, 4:30 PM EST)
A new study reveals that, despite lack of evidence, obese patients are often diagnosed with asthma. Researchers at Newark Beth Israel Medical Center in New Jersey studied 20 patients, all of whom had a diagnosis of asthma, but none of whom exhibited any spirometric evidence of airway obstruction. The body mass index (BMI) was calculated, and bronchoprovocations tests were performed. In all, 90 percent of patients had an above-normal BMI. Of that, 61 percent were nonreactive to methacholine, suggesting an overdiagnosis of asthma in obese patients. Researchers suggest bronchoprovocation testing should be considered in such patients.
Home Nebulizer Misuse May Contribute to Death
(Tuesday, October 24, 2006, 12:30 PM EST)
A new study suggests that the misuse of home nebulizers may have been a contributing cause of patient deaths in Michigan. All asthma-related deaths in Michigan, between 2002 to 2004, in patients 2- to 34-years-old, were identified. In total, 86 deaths occurred, 38 of which were children. Researchers from Michigan State University collected medical records for the year prior to death, and interviews with next of kin were obtained and examined by an expert panel. It was determined that out of the 52 patients prescribed a home nebulizer, only 30 patients used it regularly, and 19 patients used it prior to the fatal event. Researchers suggest that home nebulizers were not used in accordance with the National Asthma Education and Prevention Program (NAEPP) guidelines and that their misuse may have been a contributing factor in some deaths.
New Surgery For Asthma Improves Symptoms
(Tuesday, October 24, 2006, 12:30 PM EST)
A new surgical procedure that reduces the amount of a person's airway smooth muscle has the potential to decrease asthma symptoms caused by bronchoconstricition, according to a new study. Researchers from Canada conducted a randomized, multicenter study to examine the effect of bronchial thermoplasty on patients with moderate-to-severe, persistent asthma. A total of 108 subjects were enrolled and received standard medical management and bronchial thermoplasty. Subjects were evaluated at weeks 12, 26, and 52. Compared with a control group, patients in the bronchial thermosplasty group showed an average 50 percent reduction in mild exacerbation rates after one year. Also, patients in this group who were taking inhaled corticosteroids showed significant improvement in their asthma status.
Job Safety Education Can Reduce Respiratory Symptoms
(Wednesday, October 25, 2006, 12:30 PM EST)
Professional cleaners who do not receive or understand workplace safety education are more likely to experience occupational asthma, according to a new study. Canadian researches preformed a work-place safety survey of 566 professional cleaners. Subjects were surveyed about asthma history and their degree of safety training comprehension. Among those surveyed, 94 percent reported receiving training, and 13 percent reported having difficulty understanding the topics. Those who did not receive training and men with a post-high-school education who found it hard to understand the training were more likely to experience work-related asthma symptoms. Physician-diagnosed and new-onset asthma were increased in both sexes with an education level greater than high school. This study is the first of its kind to link inadequate workplace safety education with an increased incidence of occupational asthma.
Diabetes Increases Asthma Prevalence
(Wednesday, October 25, 2006, 2:30 PM EST)
A new study reveals that the prevalence of asthma is significantly higher in patients with type II diabetes mellitus (DM), independent of other comorbid conditions. California researchers reviewed data from 293,124 patients with DM and 552,623 patients with hypertension but no DM (control group). Using multivariate analysis, researchers found that DM remained independently associated with asthma, which was present in 4.5 percent of patients with DM vs 2.9 percent of controls. Researchers suggest an asthma diagnosis in patients with DM and respiratory symptoms should be considered.
CARDIOVASCULAR DISEASE
Medicare Part D May Hurt Heart Patients
(Monday, October 23, 2006, 4:30 PM EST)
The new Medicare Part D program may make it difficult for a significant number of indigent patients with systolic heart failure (SHF) to access evidence-based medical therapies, according to new research. Researchers followed 382 patients with SHF belonging to Louisiana's Chabert Medical Center's SHF disease management program. Patients had Medicare, and many utilized pharmaceutical-sponsored, medication-assistance programs (MAP) to access their life-saving therapies. MAP programs are potentially threatened as a result of the current change over to Medicare Part D. Patients had a mean age of 66.7 years and a median household income of $11,800 annually. In total, 95 percent of these patients with SHF used ace inhibitors, 96 percent used beta-blockers, and 65 percent obtained their medications via the MAP. Researchers conclude, that as a result of Medicare Part D payments and copayments, a considerable amount of patients with SHF may lose access to medications.
Heart Murmurs More Common in Women
(Wednesday, October 25, 2006, 2:30 PM EST)
More than half of heart murmurs are innocent in origin and more prevalent in women, according to a new study out of the University of California, Irvine Medical Center. Researchers reviewed 7,684 echocardiograms for valvular abnormalities, which were referred with the primary diagnosis of a murmur. Of the 45 percent of echocardiograms referred for a murmur, 61 percent were of women. Though patients referred for murmur had more valvular abnormalities than those referred for other reasons, researchers found that the prevalence in this group was less than 50 percent. Furthermore, despite the high number of female murmur referrals, the percentage of abnormal valves in women was only 45 percent, compared with 53 percent in men.
Smaller Arteries May Reduce a Woman's Likelihood for Successful Catheterization
(Wednesday, October 25, 2006, 2:30 PM EST)
A new study shows that smaller arterial size in women may account for the reduced likelihood of successful catheterization. Over a four-month period, researchers from New York recorded the age, body mass index (BMI), and gender of 40 patients requiring arterial catheters. Radial and femoral arteries were measured, and the association between their size and patient characteristics was assessed. Researchers concluded that, even after adjusted for age and BMI, the diameters for both radial and femoral arteries were significantly smaller in women than in men, possibly causing unsuccessful catheterizations in critically ill women.
Small Eye Syndrome Associated With Congenital Heart Disease
(Wednesday, October 25, 2006, 2:30 PM EST)
Patients with microphthalmia (MAC) have an increased risk of congenital heart disease (CHD) and other malformations, according to a new study. The disease, also known as Small Eye Syndrome, causes eye defects and is only seen in about two of every 10,000 births. Researchers from Albert Einstein Medical Center examined 225 cases and collected data about malformations associated with MAC. A subanalysis was performed to determine if a correlation between CHD and malformations was predictable. Researchers found that the incidence of CHD was significantly higher in patients with MAC, than it was in the general population. Furthermore, if CHD was present in patients with MAC, the incidence of malformations was significantly increased.
Prolonged Ventilation in Muscular Dystrophy Increases Complications
(Wednesday, October 25, 2006, 12:30 PM EST)
New research from MetroHealth Medical Center in Ohio suggests that patients with Duchenne muscular dystrophy experience a higher incidence of noncardiopulmonary complications when prolonged survival involved assisted ventilation. Researchers conducted a retrospective chart review of 27 patients with DMD who were 20-years-old or older. A patient was considered to have had prolonged survival due to assisted ventilation, if that patient lived for more than five years after vital capacity fell below 1 L. In all, 19 patients suffered from one or more complications. Eighteen of these patients showed a survival mean of 6.5 years after their vital capacity fell below 1 L. Twelve of these patients were ventilated 24 hours a day. Researchers concluded that the there is a high frequency of major noncardiopulmonary complications in patients with Duchenne muscular dystrophy and ventilator-assisted prolonged survival, and those therapies for these complications impose additional risks.
COPD
"Umbrella" Valve Provides Alternative to Lung Surgery
(Monday, October 23, 2006, 4:30 PM EST)
A new umbrella-like valve may help patients with emphysema breathe easier and provide a nonsurgical option for patients who are not good candidates for surgery. Researchers from the University of Pennsylvania, Cleveland Clinic Foundation, Duke University Medical Center, and six additional US medical centers examined the safety and effectiveness of the IBV
Vitamin C May Aid in COPD/Pneumonia Prognosis
(Wednesday, October 25, 2006, 2:30 PM EST)
During exacerbation, vitamin C is markedly decreased in inflammatory diseases, such as acute pneumonia and COPD, according to a new study. Serbian researchers compared the values of serum ascorbate concentration and laboratory inflammation indicators in 60 nonsmoking patients. The patients were split into three groups: 20 patients with acute pneumonia (group I), 20 patients with stable COPD (group II), and 20 patients with exacerbated COPD (group III). Researchers concluded that patients in groups I and III had significantly decreased levels of vitamin C and increased inflammation before therapy, compared with patients after therapy. It is suggested that the elevation of vitamin C in serum is a good prognostic parameter for disease evaluation.
Hyperglycemia in COPD May Lead to Longer Hospital Stays
(Wednesday, October 25, 2006, 2:30 PM EST)
Patients hospitalized with COPD and asthma exacerbations are likely to have poor glucose control and an associated increased length of stay (LOS) in the hospital, according to a study from Cooper University Hospital. Sixty-seven patients hospitalized for COPD or asthma exacerbations were evaluated for hyperglycemia and a correlation with LOS during corticosteroid treatment. Researchers assessed demographic data, corticosteroid dose and duration, glucose levels, and management. Researchers concluded poor glucose control and increased LOS were associated. Also, upon discharge, glucose monitoring with insulin coverage was not routinely prescribed to these patients.
COPD Underdiagnosed and Undertreated in Smokers
(Wednesday, October 25, 2006, 2:30 PM EST)
A new study suggests clinicians should be more aware of possible COPD in patients at risk for lung cancer. Researchers from the University of Alabama obtained the demographic, medical, and spirometric information of 449 subjects who smoked and were enrolled in the National Lung Screening Trial. Subjects were classified into Global Initiative for Obstructive Lung Disease (GOLD) stages, and those who had a diagnosis of COPD and were treated. In all, 53 percent had airway obstruction, and 36 percent had at least GOLD stage II. Of the 34 percent of subjects who carried a diagnosis of COPD, only 18 percent were treated. Researchers concluded that, based on traditional teachings, significant airflow obstructions occurred more frequently than expected.
COPD Progression More Rapid in Smokers
(Monday, October 23, 2006, 4:30 PM EST)
Patients with COPD, who continue to smoke, have the worst disease prognosis, according to a new study. Researchers from Illinois and Massachusetts collected the pyrometer data of 538 participants from the Framingham Heart Study. The participants were categorized according to Global Initiative for Obstructive Lung Disease (GOLD) stages at the beginning and end of 12 years, and smoking status, age, and gender were used to estimate disease progression. Participants were categorized as never smokers (16.1%), always smokers (42.5%), and intermittent smokers (37.6%). When stratified by smoking status, always smokers were shown more likely to have disease progression, having the lowest proportion of patients in the same GOLD stage at baseline and 12 years.
Sildenafil May Improve Daily Activities in COPD
(Wednesday, October 25, 2006, 2:30 PM EST)
Patients who suffer from COPD may benefit from agents, such as sildenafil, that cause vasodilation, according to researchers from the Netherlands. The new study investigated the acute effects of sildenafil on patients with COPD both at rest and during exercise. The response was also tested on patients with COPD both with and without pulmonary hypertension (PH), which is a common complication of COPD. A total of 12 patients underwent heart catheterization, and both the mean pulmonary artery pressure and cardiac output were assessed. Three-minute cycling measurements were taken at baseline and then again 45 minutes after oral intake of sildenafil. Half of the patients were found to have PH. Researchers found that in all patients, sildenafil significantly lowered pulmonary arterial pressure during exercise. However, in the group without PH, pressure was reduced in both exercise and while at rest.
Long-Acting Beta Agonists Show No Link to Cardiac Events
(Tuesday, October 24, 2006, 2:30 PM Eastern)
Patients with COPD who take inhaled long-acting beta agonists (LABAs) are not at an increased risk for developing cardiovascular events (CVEs) due to their medication, shows a new study out of the University of Washington. Researchers compared 6,954 patients with COPD who used LABAs with a matched control group of 34,700 patients with COPD. Patients were followed until the earliest CVE, death, or five years after the start of the study. Results showed that patients using LABAs had a similar risk of experiencing a CVE compared with patients who never used LABAs. Furthermore, when researchers adjusted for cumulative use of LABAs, they found that as patients used LABAs for a longer time, their risk for CVEs remained similar to patients who were never exposed to LABAs.
CRITICAL CARE
Lack of Communication Is Frequent in ICU and End-of-Life Care
(Wednesday, October 25, 2006, 2:30 PM EST)
A new study shows families of patients in the intensive care unit (ICU) are not satisfied with the amount or kind of communication they receive from health-care providers. Researchers from Harvard Medical School administered 25 open-ended questions to 50 ICU patient families. Qualitative analysis revealed an overall 40 percent communication failure rate between the families and the health-care team. Only 35 percent of families were satisfied with the information about the current status of their loved one. In a similar study, researchers interviewed family members of patients who died in the ICU. While 54 percent of family member comments were classified as positive regarding the ICU dying experience, 71 percent of the comments showed a poor experience when related to communication. Both studies suggest that communication is problematic in the ICU and end-of-life ICU situations.
Diaphragm Atrophy Occurs Within Two Weeks of Mechanical Ventilation
(Wednesday, October 25, 2006, 2:30 PM EST)
Ventilated, acutely critically ill patients may experience significant diaphragmatic atrophy within the first two weeks of mechanical ventilation, according to a new Mt. Sinai School of Medicine study. Researchers used bedside ultrasound and charts to determine the diaphragm thickness of 20 intensive care unit (ICU) patients, within 48 hours of intubation. Weekly follow-up images were obtained until patients were either removed from the ventilator or died. Researchers found a significant decrease in thickness from baseline, showing a 17 percent reduction by week one and 20 percent reduction by week two. No further loss was shown from week three and beyond. Researchers suggest that the diaphragmatic atrophy may contribute to difficulty in weaning patients from mechanical ventilation.
Pre-existing Medical Conditions Common in Pregnant Women in ICU
(Wednesday, October 25, 2006, 2:30 PM EST)
A large proportion of pregnant women admitted to the ICU are shown to have pre-existing medical conditions, according to a new study. Researchers from Rhode Island described obstetric ICU admissions by collecting and reviewing data, such as age, race, and pre-existent conditions. In all, 47 percent of the women had major pre-existing medical problems, with cardiac diseases being the most common. Twenty percent of the women had asthma and 65 percent of the admissions were for non-obstetric causes. Researchers also found that 17 percent of the total population was African-American, representing a disproportionate number.
Computerized Physician Order Entry May Improve ICU Care
(Wednesday, October 25, 2006, 2:30 PM EST)
Intensive care unit (ICU) safety protocols may be improved with use of the computerized physician order entry (CPOE) systems, says a new study. The system, which allows physicians to order medications or laboratory results via a computer, alerts physicians when a potential error is made. Researchers from Baystate Medical Center evaluated medication use in ICU patients, one year proceeding and one year following CPOE implementation. In the year following CPOE transitioning, medication administration for deep vein thrombosis (DVT) increased by 12 percent. In addition, the use of compression devices for stress ulcers increased by eight percent. Researchers concluded that CPOE systems might be associated with improved ICU care.
Obesity Associated With Bloodstream Infection Survival
(Wednesday, October 25, 2006, 2:30 PM EST)
Bloodstream infections have a high mortality rate among intensive care unit (ICU) patients. However, a new study shows that obese patients may have a survival advantage in this condition. The relationship between body mass index (BMI), survival, and hospital outcomes was evaluated in 183 critically ill patients with bloodstream infections. Researchers from Geisinger Medical Center grouped patients by their BMI ranges and made between-group comparisons for survival with hospital discharge. Researchers found that 38 percent of patients died during hospitalization. Of those who survived, obese patients were shown to have increased survival, compared with non-obese patients. Researchers concluded that the response to bloodstream infections in obese patients might lead to development of effective treatment for patients of all body types.
Telemedicine Provides Support and Enhances Physician Compliance
(Monday, October 23, 2006, 4:30 PM EST)
A new study from Indiana's Parkview Hospital Indiana suggests intensive care unit (ICU) telemedicine programs can extend intensivist care. Researchers evaluated the preliminary outcomes and nursing satisfaction at five hospitals, by involving a remote tele- intensivist in 64 rapid response team (RRT) calls. During the 16-week program, the tele-intensivist provided immediate care orders in 70 percent of cases, cardiac arrests declined by ten percent, and nursing satisfaction improved. Researchers conclude the tele-intensivists can successfully provide expert support to multiple hospital RRTs.
DISASTER RESPONSE/MEDICINE
Chemical Protective Gear Limits Exercise Capacity
(Tuesday, October 24, 2006, 12:30 PM EST)
Respiratory and chemical protective equipment used by firefighters and military personnel significantly reduces exercise capacity, according to a new study. Researchers from Texas measured the effect of the equipment on 22, healthy, active-duty soldiers. Each participant performed three exercises, a minimum of one week apart, wearing different clothing and gear for each test. When exercising with a chemical protective mask or the full protective suit, participants showed a significant decrease in oxygen uptake and oxygen pulse.
Evacuation Processes During Hurricanes Katrina and Rita Lacked Planning
(Tuesday, October 24, 2006, 2:30 PM EST)
Multiple, complex issues led to the poor evacuation response during Hurricane Katrina, says a new study. Researchers from Louisiana interviewed ten senior officials from New Orleans hospitals and reviewed published accounts of the experience. Of the variety of cited reasons for the poor evacuation response, researchers included issues, such as poor hospital infrastructure, lack of planning and communication, and inadequate coordination. A similar study out of the University of Texas examined the reasons for deaths during Hurricane Rita and concluded that 90 of 111 deaths resulted from the mass evacuation. Researchers from both studies suggest revisions to hospital disaster evacuation plans.
LUNG CANCER
Air Flow Obstructions May Predict Lung Lesions
(Tuesday, October 24, 2006, 12:30 PM EST)
New research suggests that airflow obstructions determined by spirometry may predict premalignant lung lesions. Using a cohort of subjects who visited lung cancer screening clinics from 1996 to 2005, researchers from the Roswell Park Cancer Institute in New York analyzed the relationship between spirometric parameters of airflow obstruction and central premalignant lung lesions. All of the patients underwent simple spirometry, and 269 high-risk patients received autoflouorescence bronchoscopy with endobronchial biopsy of suspicious legions. In total, 61 biopsy results were normal, while 123 confirmed either early or invasive central lung cancer. Researchers also found that patients with FEV1 less than 70 percent were associated with almost twice the risk of detecting premalignant or malignant lesions. Researchers suggest that spirometry used with autofluorescence bronchoscopy is a potential marker for lung cancer surveillance.
Radiation to Healthy Lung Associated With Pulmonary-Related Death
(Monday, October 23, 2006, 12:30 PM EST)
A new study reveals that fatal pulmonary-related events following radiation therapy are associated with the amount of radiation received by the contralateral or healthy lung. Researchers from Anderson Cancer Center in Texas investigated the incidence of fatal pulmonary events in 63 patients with mesothelioma who underwent intensity modulated radiation therapy and extrapleural pneumonectomy. Endpoints were pulmonary-related death (PD), classified as death from pneumonia within six months of intensity modulated radiation therapy, or noncancer death, including all deaths except those related to PD or cancer. Researchers concluded that of the 10 percent of patients who died from PD, all had received significantly more radiation to their contralateral lung, compared with noncancer death patients.
Radiofrequency Ablation in Inoperable Lung Cancer Yields Results
(Tuesday, October 24, 2006, 2:30 PM EST)
Patients with lung cancer who were deemed medically inoperable showed mid-to-long-term results when treated with radiofrequency ablation (RFA), according to new research. Over a 30-month period, 16 patients with non-small cell lung cancer underwent 19 RFA treatments and follow-up CT-PET scans. Researchers from Massachusetts General Hospital noted successful completion in all patients, with no 30-day mortality, and 81 percent of patients remained alive after a mean follow-up of nine months. Also, the incidence of major complications remained low. Researchers concluded that RFA treatment in carefully selected, inoperable, lung cancer patients provides excellent control in tumors less than three centimeters.
Lung Cancer Symptoms Have Not Changed
(Tuesday, October 24, 2006, 12:30 PM EST)
Despite technologic advances, the presenting symptoms of lung cancer (LC) have not changed over time, according to a new study. In order to update information on the modern presentation of LC, researchers from the Cleveland Clinic Health System and Cleveland Clinic Foundation conducted a retrospective chart review of 228 patients who presented with lung cancer within the two years prior to the study. Common symptoms on presentation included cough, dyspnea, weight loss, and chest pain. Of the total population, 14.6 percent (42) of patients were asymptomatic and 48 percent (144) had COPD on presentation. Asymptomatic patients were found more likely to have had previous cancer, but less likely to have COPD, when compared with symptomatic patients. Patients without COPD had a lower incidence of cough and dyspnea, than did patients with COPD. Researchers conclude that the presenting features of LC have not changed with the advances in imaging technology.
OBESITY
Obese Children More Likely To Be Admitted for Asthma
(Tuesday, October 24, 2006, 4:30 PM EST)
A new study reveals that obese children with asthma are significantly more likely to be admitted to the hospital for acute asthma exacerbations than their non-obese counterparts. Researchers from the Connecticut Children's Medical Center conducted a retrospective chart review of 813 children over the age of two, who presented to the emergency department with asthma exacerbations. Twenty-seven percent were admitted to the hospital, and four percent to the intensive care unit. Of the children classified as obese, 34 percent were admitted to the hospital, compared with 25 percent of the non-obese children. The obese children were also more likely to be older and live in an impoverished area.
PEDIATRIC PULMONOLOGY
Lung Transplants in Pediatric Cystic Fibrosis Fails To Improve Survival
(Tuesday, October 24, 2006, 4:30 PM EST)
A new study from the University of Utah suggests that lung transplantations in pediatric patients with cystic fibrosis (CF) do not increase survival and may actually be harmful. Researchers examined 558 patients under the age of 18 who were listed for lung transplantation and an additional 265 patients who had a transplant. Factors associated with increased hazard of lung transplantation included infection, high FEV1, and diabetes for those on the waiting list, and age and infection for those after transplantation. Researchers concluded that lung transplantation may be harmful for pediatric patients with CF and that transplantation likely reduces survival rather than improving it.
Indoor Particulate Matter Increases Symptoms in Preschoolers
(Tuesday, October 24, 2006, 4:30 PM EST)
Reduction of indoor particulate matter (PM) levels in the homes of preschool-aged children with asthma should be targeted to improve respiratory health, states a new study. The study, from Johns Hopkins University, tested the effect of indoor PM exposure on the health of 150 asthmatic children, ages 2 to 6 years. Researchers suggest that children this age spend 90 percent of their time indoors, so indoor air from the children's homes was sampled for three-day time periods at baseline, three, and six months. In addition, caregivers filled out questionnaires. Researchers concluded that increased PM exposure in these children was associated with greater symptoms, rescue medication, and functional limitation.
Lung Disorder in Premature Babies Shows Presence After Three Years
(Wednesday, October 25, 2006, 12:30 PM EST)
Premature babies born with bronchopulmonary dysplasia (BPD) continue to exhibit respiratory symptoms after three years of life, according to a new study from Baylor College of Medicine. The lung disorder is most commonly seen among premature infants with very low birth weight, who have received prolonged mechanical ventilation. Researchers followed 31 children with BPD for 36 months following discharge. Eighty-two percent of these children were less than 2.2 pounds at birth. Visits were conducted every three months, from three months of age to one year; and every six months, from one year to two years; and then concluded with a visit at three years. Pulmonary function tests were performed at 6, 12, and 24 months. Results showed that 45 percent of children showed persistent airway obstruction at 24 months, and 75 percent of children reported cough at 36 months.
Sleep Apnea and Snoring Disorder Differ in Children
(Wednesday, October 25, 2006, 12:30 PM EST)
A new study shows that the differences between obstructive sleep apnea (OSA) and primary snoring disorder (PSD) in children are significant. Researchers from the University of Texas Health Science Center reviewed patient charts of 309 children, ages 6 to 17, who underwent consecutive polysomnograms. Measurements, such as daily caffeine intake, height, weight, blood pressure, and neck circumference were gathered from prior examinations. Researchers defined OSA as an obstructive apnea-hyponea index greater than one. In all, 106 patients had OSA, 113 had PSD, and 90 had normal results. Body mass index and neck circumference were among the most statistically different between patients with OSA and patients with PSD.
Low Birth Weight Not Linked to Poor Lung Function
(Wednesday, October 25, 2006, 2:30 PM EST)
Babies born at term with low birth weight (LBW) have minimal risk of experiencing poor lung function as adolescents, shows a new cross-sectional study. Researchers from the Philippines performed pulmonary function tests on 41 children, ages 10 to 14, to determine their FEV1 and FVC. All of the children were delivered healthy and at term, but with LBW. Other information, such as present height and weight, body mass index, smoking, and illness were recorded. Researchers concluded that there is a weak correlation between LBW and lung function among early adolescences, and only those children who experience pneumonia at less than two years showed a statistically significant change in FVC.
PULMONARY FUNCTION TESTING
Poor Lung Function Test Results Increase Postoperative Death
(Tuesday, October 24, 2006, 2:30 PM EST)
New research shows preoperative pulmonary function tests (PFT) with poor results are associated with increased postoperative death and other complications. Researchers from the Cleveland Clinic Foundation performed preoperative PFTs on 2,742 patients undergoing primary elective cardiac surgery. Variables related to hospital death, respiratory failure, and long-term mortality, among others, were also analyzed. The study showed an increased risk of postoperative mortality, pulmonary complications, and sternal infection in those patients with poor PFT findings. Researchers conclude that PTFs should be performed to screen for undetected pulmonary disease.
Inmates Show Lack of Effort in PFTs
(Wednesday, October 25, 2006, 2:30 PM EST)
Incarcerated patients (ICP) are more likely to exhibit inadequate patient effort in pulmonary function tests (PFT), when compared with unincarcerated controls, according to a new study. Considering that PFTs are effort-dependent and that there are multiple motivations for ICPs to intentionally perform poorly, researchers from Mount Vernon Hospital in New York, compared PFT scores of 156 ICPs with scores from matched unincarcerated patients. Results showed that 86.5 percent of ICPs had an abnormal PFT, compared with 70.5 percent of controls. Researchers also found that 31 percent of the abnormal PFT in ICPs were due to inadequate effort, compared with 4 percent in controls.
Race-Specific Spirometry Increases Diagnostic Accuracy
(Tuesday, October 24, 2006, 12:30 PM EST)
New research suggests that the use of race/ethnic-specific reference equations increase the accuracy of spirometric interpretation. Researchers from the Brooke Army Medical Center in Texas conducted a retrospective analysis of physician interpretation of spirometry before and after a change in the reported reference values. When references were not race/ethnic-specific, physicians were instructed to use adjustment factors. Overall, the use of race/ethnic-specific values led to an increase in physician diagnostic accuracy, which was reflected more in the diagnostic accuracy of identifying restriction.
PULMONARY HYPERTENSION
Inhaled Iloprost May Increase Airway Obstruction in Children
(Wednesday, October 25, 2006, 12:30 PM EST)
A new study shows that inhaled iloprost, recently introduce to treat pulmonary arterial hypertension (PAH), can lead to acute lower airway obstruction in children. Researchers from both Texas and Denver Children's Hospitals obtained pre- and post-iloprost inhalation spirometry on 12 children diagnosed with PAH. All patients were on oral pulmonary vasodilator therapy during testing. In all, 5 of the 12 patients experienced a forced expiratory flow decrease of more than 15 percent, and four showed a drop of seven percent or more. Chest pain was also reported as an adverse effect, possibly resulting from airway reactivity following the inhalation of iloprost. Researchers suggest pulmonary function testing be performed on all children with PAH before and after inhaled prostacyclin therapy is initiated.
Inhaled Iloprost Well-Tolerated in Children With PAH
(Wednesday, October 25, 2006, 12:30 PM EST)
Inhaled iloprost administered to children with pulmonary arterial hypertension (PAH) was shown to be safe and effective in a new study from the University of Colorado/Children's Hospital and Texas Children's Hospital. Eleven children with PAH were treated with inhaled iloprost five to nine times daily, for 3 to 11 months. Researchers compared pretreatment responses with iloprost vs inhaled nitric oxide during cardiac catheterization. Results showed no change in FEV1 and forced expiratory flow in pulmonary function tests performed pre- and posttreatment. Researchers concluded that iloprost therapy in children with PAH was safe, well tolerated, effective, and predictive of clinical response to chronic therapy.
Thyroid Dysfunction Prevalent in Patients With Pulmonary Hypertension
(Wednesday, October 25, 2006, 2:30 PM EST)
New research suggests that adults with pulmonary hypertension (PH) are more likely to experience thyroid disease than the general population or other patients with comparable pulmonary disease. A study of 358 patients with PH, seen at Mayo-Clinic Jacksonville over a 14-year period, was performed, and matched controls were randomly selected. Research showed that thyroid disease was present in 31 percent of the PH group, compared with only 15 percent in the control group. Also, at the time of initial PH evaluation, only about 55 percent of patients with hypothyroid were adequately treated. However, despite the high prevalence of thyroid disease, treatment did not seem to affect the severity of the PH.
SLEEP MEDICINE
Sleep Apnea and Diabetes May Be Related
(Tuesday, October 24, 2006, 2:30 PM EST)
According to new research, obstructive sleep apnea syndrome (OSAS) and diabetes mellitus (DM) may be associated. Using the electronic charts of patients referred for sleep studies over one year, researchers from Quillen College of Medicine in Tennessee identified 127 patients with DM. Data collected included age, gender, and body mass index, as well as the presence of the kidney condition microalbuminuria; microvascular complications, such as retinopathy/neuropathy; or macrovascular complications, such as coronary artery disease and stroke. Overall, OSAS was directly related to microalbuminuria, microvascular, and macrovascular complications. Researchers concluded that, despite being independent diseases, OSAS might directly contribute to DM complications.
Men With Apnea May Be Sleepier Than Women
(Wednesday, October 25, 2006, 2:30 PM EST)
Men with mild obstructive sleep apnea may have more sleep fragmentation and daytime symptoms than their female counterparts, according to a new study from Marshall University. Researchers assessed the differences in clinical presentation and polysomnographic profile between 31 men and 32 women with mild obstructive sleep apnea. In all, 12 parameters were examined, in which 3 of them showed a significant difference between the sexes. Men had more witnessed apnea, spent more time in stage 1 sleep, and less time in stage 2 sleep, than women. As a result, researchers suggest that physicians may consider a lower continuous positive airway pressure therapy threshold for men.
African-Americans Report Less Sleep Than Caucasians
(Wednesday, October 25, 2006, 2:30 PM EST)
A new prospective study of morbidly obese patients revealed that African-Americans self-reported less average sleep duration compared with Caucasians. Researchers from Metrohealth Medical Center in Ohio analyzed 251 patients undergoing polysomnography. Sleep questionnaires were administered and self-reported sleep duration was reported. Demographic information, such as age, gender, race, and comorbid conditions were also included. While researchers did not find a relationship between body mass index (BMI) and sleep duration, they did find that despite age, BMI, or caffeine or alcohol intake, African-Americans reported less sleep duration.
Obstructive Sleep Apnea May Increase Complications After Heart Surgery
(Wednesday, October 25, 2006, 2:30 PM EST)
New research from the Cleveland Clinic Foundation suggests that cardiac surgery patients with obstructive sleep apnea (OSA) are at a higher risk for developing postoperative complications. Researchers compared the incidence of cardiac surgery complications in 37 patients with OSA, identified through the cardiac surgery database, with another database sample absent of OSA. Patients, who underwent open-heart surgery within two years of an OSA diagnosis, were assumed to have had OSA at the time of surgery. Researchers found that the patients with OSA exhibited a higher incidence of encephalopathy, postoperative infection, and increased length of intensive care unit stays. It is suggested that this risk is underestimated due to lack of OSA incidence awareness and that patients may need to be screened for OSA prior to cardiac surgery.
Education Increases Compliance in CPAP Patients
(Tuesday, October 24, 2006, 2:30 PM EST)
Patient education and mask acclimatization are shown to increase compliance among people who participate in continuous positive airway pressure (CPAP) therapy, says a new study. Researchers from Yale University and Bridgeport Hospital divided 88 CPAP patients into two groups; those who received education and acclimatization prestudy (intervention group) and those who received traditional education only, or poststudy (control group). All patients received humidification and followed-up at one, three, and six months. Compliance data downloaded from the CPAP machine showed only eight percent of patients failed to use CPAP, compared with 31 percent of controls. Researchers concluded that there was more compliance, both in hours per night and nights per week used, in the intervention group.
CPAP Treatment in Commercial Drivers Reduces Employer Health Costs
(Wednesday, October 25, 2006, 12:30 PM EST)
A new study shows significant savings in health-care expenditures for commercial carriers when their truck drivers' sleep apnea is treated. Between January 2003 and December 2005, researchers from Texas, Wisconsin, and Minnesota analyzed 339 commercial truck drivers with newly diagnosed sleep apnea. All drivers received a continuous positive airway pressure (CPAP) machine for treatment. Data were collected before and after CPAP intervention and included rates of hospital admission, emergency department, office visits, and total health-care spending. Researchers found that after CPAP intervention, there was an average savings of $538, per member per month, or a 57.4 percent reduction in per-member-per-month total health-care costs. In addition, inpatient hospital admissions showed a reduction of 91 percent after CPAP was used. Researchers conclude that companies can enjoy large reductions in corporate health-care by attempting to identify and treat employees with sleep apnea.
SMOKING
Exercise May Help Smokers Quit
(Tuesday, October 24, 2006, 4:30 PM EST)
According to Austrian researchers, exercise-training therapy is an effective smoking cessation aid without side effects. The new study examined whether exercise-based interventions combined with a smoking cessation program are more effective than a cessation program alone. Sixty-eight smokers participated and were randomly given either nicotine replacement therapy or nicotine replacement therapy with exercise training for three months. Forced expiratory volume (FEV1) and exhaled carbon monoxide were measured. While significant cigarette cessation was achieved in both groups, 80 percent in exercise training quit smoking, compared with 52 percent in the nicotine replacement therapy group. Researchers conclude that exercise training together with nicotine replacement therapy is feasible and aid smoking cessation.
Stressful Events Should Not Prohibit Smoking Cessation
(Tuesday, October 24, 2006, 4:30 PM EST)
Stressful life events do not decrease a smoker's chances of quitting the habit, a new study reveals. Researchers from North Shore Long Island Jewish Health Systems examined the impact of stressful life events in 1,330 smokers being treated for tobacco dependence. Self-reported information, including medical history, quitting obstacles, quit attempts, and current major stressors, were gathered on day one, via questionnaires. Using a carbon monoxide monitor, quit status was determined at 30 days and one year. Forty-one percent of smokers experienced one or more major stressful events during treatment, such as change in marital status and change in job. Though stressed smokers were more likely to "light up when upset" at 30 days, 50 percent quit, compared with 60 percent of nonstressed smokers. At the one-year mark, there was no difference shown in quit success. Researchers conclude that many smokers who reported major stressful event during treatment were able to successfully quit; therefore, stressful life events should not be a smoking cessation obstacle.
Chronic Cough and Sputum Linked to Secondhand Smoke
(Wednesday, October 25, 2006, 2:30 PM EST)
According to a new study, secondhand smoking is associated with chronic cough and sputum production. Researchers from the University of California, Irvine, studied the association of secondhand smoking and respiratory symptoms in 139 patients from a Veterans' Administration Medical Center who underwent left ventricular ejection fraction measurements for clinical reasons. The presence of chronic cough, sputum production, and secondhand smoking, and association between the three were evaluated. Compared with controls, secondhand smokers showed a significant association with chronic sputum production and also showed a trend toward an increased prevalence of cough. Clinical implications suggest that secondhand smoking has a deleterious effect on lung function.
GENERAL PULMONARY
Difficulty Swallowing May Contribute to Treatment Failure in Chronic Cough
(Wednesday, October 25, 2006, 2:30 PM EST)
New research suggests that mild dysphagia--or difficulty swallowing--in patients with chronic cough may contribute to treatment failure. University of California researchers performed modified barium swallow tests on 61 patients with chronic cough who met the following criteria: minimal sputum production, nonsmoker, no infection/malignancy, and failure to respond to initial therapy. Overall, the swallow test was normal in only three patients, while various manifestations of dysphagia were observed in all other patients. It was concluded that dysphagia is frequent in patients with chronic cough who are unresponsive to therapy. Researchers also suggest that dysphagia may be a contributing factor to treatment failure.
Surgical Glue Yields Fewer Complications and Less Cost
(Monday, October 23, 2006, 4:30 PM EST)
Thoracic surgery complications and hospital charges are shown to reduce significantly with the use of fibrin glue, shows a new study by Italian researchers. The glue is used to prevent common postoperative complications of thoracic surgery, such as air leaks and bleeding. In this case-control study, 150 patients underwent surgery for primary or metastatic lung disease. Half of the patients were treated with fibrin glue on air leak zones or lacerations (group one), and half were treated with standard techniques, such as electrocauterization and sutures (group two). Results showed that air leak duration and drain time were significantly less in group one. Also, group one had one case of prolonged air leak complication, compared with 12 cases in group two. The median hospital stay was three days longer for those in group two, and patients in group one had an overall cost savings of 28 percent.