Latest in Pulmonary News

Latest in Pulmonary News2019-02-15T07:28:32+00:00

Lies, Damned Lies, and Asthma

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 the National Institutes of Health National Asthma Education and Prevention Program (NIH-NAEPP) Expert Panel Report (EPR-1) in 1991.2 Here I offer an updated list of do’s and don’ts and a perspective from one clinician’s experience with difficult-to-control asthma since 1998 ……

Samuel Louie, MD
Professor of Medicine, Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine; and Director, UC Davis Asthma Network (UCAN) at UC Davis Health, Sacramento, California

Louie S. Lies, damned lies, and asthma. Consultant. 2018;58(12):336-342.


What exercises can help increase lung capacity?

Patients with asthma, COPD or other chronic lung conditions always asks me whether exercise can reverse or improve the disease or improve lung capacity? Generally speaking, breathing exercises or pulmonary rehab program does not improve pulmonary functional capacity as measured by FEV1. However, they can perform exercises that may reduce shortness of breath, anxiety, and stress, related to underlying pulmonary diseases. Pursed lip breathing, belly breathing, and interval training are related to improvements in dyspnea. Read more on detailed instruction of theses exercise program for your patients.

Thirty-Day Hospital Readmission Metric Linked to Increased Mortality for HF and Pneumonia

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 compared mortality rates among 8.3 million Medicare beneficiaries hospitalized for these common conditions before and after implementation of the Hospital Readmissions Reduction Program (HRRP). This early data should lead physicians to exercise caution in discharging patients prematurely.

Source: Association of the Hospital Readmissions Reduction Program With Mortality Among Medicare Beneficiaries Hospitalized for Heart Failure, Acute Myocardial Infarction, and Pneumonia. JAMA. 2018;320(24):2542-2552. doi:10.1001/jama.2018.19232

Add Corticosteroids to Your Arsenal for the treatment of Inpatient Community-Acquired Pneumonia.

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 routinely.

These meta-analyses suggest that low-dose (≈40 mg), short-course (3–7 days) systemic corticosteroids should be strongly considered for hospitalized adults with severe CAP. These results do not apply to outpatients with CAP or to inpatients with hospital-acquired pneumonia or ventilator-associated pneumonia. Several ongoing randomized trials probably will clarify steroid use further for pneumonia indications.

The Cost-effectiveness of Corticosteroids for the treatment of Community-Acquired Pneumonia
Chest. 2018 Nov 15. pii: S0012-3692(18)32727-2. doi: 10.1016/j.chest.2018.11.001.

Home oxygen therapy for COPD: Does it matter whether the patient is hypoxemic? Evidence vs Reality

Home oxygen therapy for COPD: Does it matter whether the patient is hypoxemic? Evidence vs Reality?

Long-term oxygen therapy (LTOT) is given to improve survival time in people with COPD and severe chronic hypoxemia at rest. The efficacy of oxygen therapy for breathlessness and health-related quality of life (HRQOL) in people with COPD and mild or no hypoxemia who do not meet the criteria for LTOT has not been established. Scientific evidence for its benefits of LTOT dates back to the 1980s when two randomized controlled trials showed prolonged survival in COPD-patients undergoing LTOT for at least 15 hours/day. In contrast, the potential benefits of LTOT in non-COPD-patients has not been well researched and the recommendations for its application are primarily extrapolated from trials on COPD-patients.

Recent Cochrane analysis found that oxygen can relieve breathlessness when given during exercise to mildly hypoxaemic and non-hypoxaemic people with chronic obstructive pulmonary disease who would not otherwise qualify for home oxygen therapy. Findings show that COPD patients without severe hypoxemia undergoing oxygen therapy during exercise training over time do not achieve better exercise capacity or health-related quality of life compared with placebo.

However, LTOT has a beneficial effect on quality of life, dyspnea, and exercise capacity in patients with COPD and exertional hypoxemia.

Oxygen for breathlessness in patients with chronic obstructive pulmonary disease who do not qualify for home oxygen therapy

J Bras Pneumol. 2018 Sep-Oct;44(5):390-397. doi: 10.1590/S1806-37562017000000019.
Impact of adherence to long-term oxygen therapy on patients with COPD and exertional hypoxemia followed for one year.

Latest in Pulmonary Research

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  7. Quintão, NLM, Pastor, MVD, de Souza Antonialli, C, da Silva, GF, Rocha, LW, Berté, TE et al.. Aleurites moluccanus and its main active constituent, the flavonoid 2''-O-rhamnosylswertisin, in experimental model of rheumatoid arthritis. J Ethnopharmacol. 2019; :. doi: 10.1016/j.jep.2019.02.014. PubMed PMID:30769038 .
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  13. Wortley, MA, Bonvini, SJ. TGFβ1 - A Novel Cause of Resistance to Bronchodilators in Asthma?. Am. J. Respir. Cell Mol. Biol. 2019; :. doi: 10.1165/rcmb.2019-0020ED. PubMed PMID:30768914 .
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  17. Popat, S. Hyperprogression with immunotherapy: Is it real?. Cancer. 2019; :. doi: 10.1002/cncr.31997. PubMed PMID:30768797 .
  18. Socié, G, Caby-Tosi, MP, Marantz, JL, Cole, A, Bedrosian, CL, Gasteyger, C et al.. Eculizumab in paroxysmal nocturnal haemoglobinuria and atypical haemolytic uraemic syndrome: 10-year pharmacovigilance analysis. Br. J. Haematol. 2019; :. doi: 10.1111/bjh.15790. PubMed PMID:30768680 .
  19. Schellenberg, M, Cobb, JP. Nosocomial Pneumonia in the ICU: Still More Questions Than Answers. Crit. Care Med. 2019;47 (3):472-473. doi: 10.1097/CCM.0000000000003600. PubMed PMID:30768505 .
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  21. Naizhen, X, Kido, T, Yokoyama, S, Linnoila, RI, Kimura, S. Spatiotemporal Expression of Three Secretoglobin Proteins, SCGB1A1, SCGB3A1, and SCGB3A2, in Mouse Airway Epithelia. J. Histochem. Cytochem. 2019; :22155419829050. doi: 10.1369/0022155419829050. PubMed PMID:30768367 .
  22. Lee, HW, Baker, E, Lee, KM, Persinger, AM, Hawkins, W, Puppa, M et al.. Effects of low dose leucine supplementation on gastrocnemius muscle mitochondrial content and protein turnover in tumor bearing mice. Appl Physiol Nutr Metab. 2019; :. doi: 10.1139/apnm-2018-0765. PubMed PMID:30768366 .
  23. Royce, SG, Mao, W, Lim, R, Kelly, K, Samuel, CS. iPSC- and mesenchymoangioblast-derived mesenchymal stem cells provide greater protection against experimental chronic allergic airways disease compared with a clinically used corticosteroid. FASEB J. 2019; :fj201802307R. doi: 10.1096/fj.201802307R. PubMed PMID:30768365 .
  24. Kutz, A, Gut, L, Ebrahimi, F, Wagner, U, Schuetz, P, Mueller, B et al.. Association of the Swiss Diagnosis-Related Group Reimbursement System With Length of Stay, Mortality, and Readmission Rates in Hospitalized Adult Patients. JAMA Netw Open. 2019;2 (2):e188332. doi: 10.1001/jamanetworkopen.2018.8332. PubMed PMID:30768196 .
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Search Terms: Asthma, COPD, Lung Cancer, Pneumonia, Pulmonary Fibrosis