Category: Pulmonary News

Over the last few months several studies has shown conflicting efficacy and safety of Hydroxychloroquine (HCQ) alone or in association with azithromycin or Doxycycline. Most recent data now published in International Journal of Infectious Diseases showing mortality benefit of HCQ alone or in association with Azithromycin in the treatment of COVID-19. In this observational study from the Henry Ford Health System in Detroit, investigators examined the in-hospital mortality of 2,541 consecutive hospitalized COVID-19 patients in four treatment categories: hydroxychloroquine (HCQ) plus azithromycin (AZM), either drug alone, or neither drug. They excluded patients who died in the first 24 hours after ... Read more

Yale Ad-Hoc COVID-19 Treatment Team algorithms and protocols – multiple algorithms are assembled into a series of color-coded guidance sheets for hospitalist and internist to use. This algorithm is last updated on 4/27/20 and as such still include Hydroxychloroquine in treatment pathway, which is not a standard of care currently. However, rest of the treatment protocols still very helpful for hospitalized patients. Download Source : https://files-profile.medicine.yale.edu/documents/e91b4e5c-ae56-4bf1-8d5f-e674b6450847

It was the arrival of the second man in his early 20s gasping for air that alarmed Dixie Harris, MD. Young patients rarely get so sick, so fast, with a severe lung illness, and this was her second case in a matter of days. Then she saw three more patients at her Utah telehealth clinic with similar symptoms. They did not have infections, but all had been vaping. When Dr. Harris heard several teenagers in Wisconsin had been hospitalized in similar cases, she quickly alerted her state health department. As patients in hospitals across the country combat a mysterious illness ... Read more

For the past several years, the trend has been to use inhaled corticosteroid(ICS) early and often for patients with asthma. And now the 2019 Global Initiative for Asthma (GINA) guidelines recommend using ICS as first-line therapy (step 1) as needed).[1] This change is sure to increase ICS use even more. The logic behind using ICS early and often is sound, but when it comes to asthma, nothing is simple. The first problem is that asthma is overdiagnosed (some estimates put the rate as high as 30%-35%).[2] Even when the diagnosis is correct, up to 50% of patients with the disease ... Read more

PURPOSE: Orofacial myofunctional therapy (OMT) is a modality of treatment for children and adults with obstructive sleep apnea (OSA) to promote changes in the musculature of the upper airways. This review summarizes and discusses the effects of OMT on OSA, the therapeutic programs employed, and their possible mechanisms of action. METHODS: We conducted an online literature search using the databases MEDLINE/PubMed, EMBASE, and Web of Science. Search terms were “obstructive sleep apnea” in combination with “myofunctional therapy” OR “oropharyngeal exercises” OR “speech therapy”. We considered original articles in English and Portuguese containing a diagnosis of OSA based on polysomnography (PSG). ... Read more

Patients who have risk factors for obstructive sleep apnea (OSA) or who report symptoms of OSA should be screened for it, first with a complete sleep history and standardized questionnaire, and then by objective testing if indicated. The gold standard test for OSA is polysomnography performed overnight in a sleep laboratory. Home testing is an option in certain instances. Common risk factors include obesity, resistant hypertension, retrognathia, large neck circumference (> 17 inches in men, > 16 inches in women), and history of stroke, atrial fibrillation, nocturnal arrhythmias, heart failure, and pulmonary hypertension. Screening is also recommended for any patient ... Read more

Aminophylline suppositories, cocaine nasal packs, and potassium iodide were commonly prescribed for asthma in 1963 when Claude A. Frazier, MD, wrote a thoughtful essay on the do’s and don’ts in treating allergic asthma in Consultant.1 How times have changed! Dr Frazier left us with several clinical observations that are prophetic. He was correct in asserting in his introduction that “allergic asthma is a problem disease; its capricious nature defies control and keeps the health of the asthmatic always in a precarious state. And, improper treatment can make the asthma worse.” His wisdom preceded the proliferation of consensus guidelines, beginning with ... Read more

The lungs are responsible for the exchange of oxygen and carbon dioxide that keep the brain, heart, and other parts of the body healthy. Age, smoking, inhaling pollutants, and other factors can affect lung function. People cannot necessarily change their lung capacity in terms of how much oxygen their lungs can hold. However, they can perform exercises that may reduce shortness of breath when they have a lower lung function than is desirable. An example could be someone who has chronic obstructive pulmonary disease (COPD). A person should always talk to their doctor before starting any exercise program, including breathing ... Read more

Physicians are at increased pressure to reduce readmissions for certain chronic diseases. A recent study found that implementation of the 30-day readmission rules has been associated with increased 30-day post-discharge mortality for those hospitalized for heart failure and pneumonia. Post-discharge deaths have increased by 0.25% for patients hospitalized with heart failure and by 0.40% for patients with pneumonia since the implementation of the 30-day readmission rules. There are approximately 8 million hospitalizations during the study period. Such small increases may account for a large number of deaths. The findings, published online in JAMA, come from a retrospective cohort study that ... Read more

Corticosteroids were both beneficial and cost-effective for hospitalized adults with severe CAP. Hospitalized people with non-severe CAP may also benefit from corticosteroid therapy, but with no survival advantage In 2015, results of two randomized trials showed that systemic corticosteroids were beneficial for some hospitalized patients with community-acquired pneumonia (CAP; NEJM JW Gen Med Mar 15 2015 and JAMA 2015; 313:677; NEJM JW Gen Med Mar 1 2015 and Lancet 2015; 385:1511). Now, two new meta-analyses — one by the Cochrane Library, and one by the Infectious Diseases Society of America (IDSA) — address whether CAP patients should receive systemic corticosteroids ... Read more