April 2nd 2025
A mail campaign targeting adults with chronic conditions as well as their GPs increased the number receiving at least 1 shot by 9.5 percentage points.
Helping Patients With COPD Breathe Easier
December 31st 2006Q:I am trying to encourage a patient with chronicobstructive pulmonary disease (COPD) to quitsmoking. He began smoking at age 14 years and hassmoked 1 pack of cigarettes a day for 35 years. His lungfunction is moderately decreased (forced expiratoryvolume in 1 second [FEV1], 65% of predicted). What othermeasures can I recommend to help restore lung functionso that he has more stamina and less shortness ofbreath on exertion?
Diagnostic Methods Equivalent for Mechanical Ventilation-Related Pneumonia
December 20th 2006KINGSTON, Ontario, Dec. 20 -- For critically ill patients on mechanical ventilation, bronchoalveolar lavage and endotracheal aspiration appear to be equally effective when diagnosing pneumonia, said researchers here.
Flu Shots Outdo Nasal Spray for Drifted Influenza
December 14th 2006ANN ARBOR, Mich. -- For seasonal flu strains that were slightly different than predicted, the traditional killed-virus vaccine in 2004-2005 was about 75% effective, while a live attenuated-virus nasal spray was less effective, researchers reported.
Drifted Influenza: Flu Shots More Effective Than Nasal Spray
December 14th 2006ANN ARBOR, Mich. -- For seasonal flu strains that were slightly different than predicted, the traditional killed-virus vaccine in 2004-2005 was about 75% effective, while a live attenuated-virus nasal spray was less effective, researchers reported.
COPD: How to Manage Early and Late Disease
December 2nd 2006The goals of therapy in chronic obstructive pulmonary disease are to ameliorate symptoms, improve daily function, preserve lung function, identify and reduce exacerbations and, if possible, decrease mortality. A comprehensiveapproach that includes prevention, early identification, and pharmacotherapy-and oxygen therapy, pulmonary rehabilitation, and/or surgery when appropriate-can optimize patient outcomes.
Clinical Citations: Exercise program improves dyspnea and mood in patients with COPD
December 1st 2006Although the estimates of prevalence vary, there is convincing evidence that patients with chronic obstructive pulmonary disease (COPD) are at increased risk for depression. Moreover, depression has been associated with diminished functional status, increased symptoms, and increased mortality in patients with COPD. Encouraging news comes from Nguyen and Carrieri-Kohlman, who report that a dyspnea self-management program that includes exercise can reduce both dyspnea and depressed mood in these patients.
Clinical Consultation: Noninvasive ventilation for COPD
December 1st 2006NPPV should be considered theventilatory modality of first choicein patients presenting to an acutecare hospital with an exacerbationof COPD. This is based on the findingsof multiple randomized controlledtrials as well as meta-analyses.These have shown that NPPVused in such patients brings about amore rapid improvement in dyspnea,vital signs, and PaCO2 thandoes oxygen therapy with standardmedical treatment. Use of NPPV resultsin significant reductions in theneed for intubation, morbidity andmortality rates, and in some studies,the length of hospital stay. These latterbenefits are unquestionably relatedto the avoidance of the complicationsof intubation, includingnosocomial infections, that increasein occurrence as the duration of intubationbecomes prolonged.
Clinical Citations: Is anxiety linked with increased asthma symptoms in adolescents?
December 1st 2006Increasing evidence demonstrates that adolescents with asthma are at greater risk for anxiety and depression. However, few studies have investigated the association of psychological disorders with asthma symptoms, an important factor in evaluating asthma treatment. Now the results of a large population-based study of adolescents with asthma confirm that anxiety and depression are highly associated with increased asthma symptoms.
Questions Physicians Often Ask About Allergens That Trigger Asthma
December 1st 2006Abstract: Because of the impact of allergen exposure on asthma control, all patients with asthma should be evaluated for allergic sensitization. Such patients can be referred to an allergist for evaluation, or radioallergosorbent tests can be ordered by the primary care provider. The major groups of aeroallergens that can trigger asthma attacks include furred-pet, dust mite, cockroach, rodent, mold, and pollen allergens. When assessing a patient's exposure history, remember that furred-pet allergens are found not just in the home, but in other settings, such as schools, and these allergens are passively transferred from one environment to another. Allergen avoidance measures are essential to the management of asthma in sensitized patients and can significantly improve asthma control. First-line dust mite control measures include installing allergen-proof mattress and pillow encasements, washing all bedding every 1 to 2 weeks in hot water, removing stuffed toys, vacuuming and dusting regularly, and reducing indoor relative humidity. (J Respir Dis. 2006;27(12):511-526)
Clinical Update: The return of influenza season: What has changed?
November 1st 2006The 2006-2007 influenza season is upon us. Influenza epidemics have been associated with an average of about 36,000 deaths per year in the United States from 1990 to 1999.1 In July of this year, the Advisory Committee on Immunization Practices (ACIP) updated its recommendations for the prevention and control of influenza.2
Clinical Citations: Race and asthma: Evaluating differences in in-hospital mortality
November 1st 2006Although the overall rates of asthma-related hospitalization and death are about 2.5 to 5 times higher among black than white patients, it has not been known whether hospital deaths also are increased in black patients with asthma exacerbations. Investigators from Johns Hopkins who studied this issue found there were no significant race differences in hospital deaths.
Clinical Citations: Recognizing pulmonary embolism in patients with COPD exacerbation
October 1st 2006When a patient with chronic obstructive pulmonary disease (COPD) presents with what appears to be an acute exacerbation, you should consider the possibility of pulmonary embolism (PE). This is the message conveyed by a prospective cohort study in France.
Clinical Citations: Can early therapy with inhaled steroids limit asthma-related damage?
October 1st 2006Can early intervention with inhaled corticosteroids help prevent irreversible lung function decline in patients with asthma? Yes, according to results of the international Inhaled Steroid Treatment as Regular Therapy in Early Asthma (START) study.
Clinical Citations: What are the short-term effects of smoking cessation on asthma?
October 1st 2006Perhaps surprisingly, limited published data exist on the effects of smoking cessation on symptoms, lung function, and corticosteroid responsiveness in smokers who have asthma. However, in a prospective controlled study, Scottish researchers found that 6 weeks af-ter smoking cessation, patients with asthma had significant improvement in lung function and a decrease in sputum neutrophil count compared with patients who continued to smoke.
Methicillin-Resistant Staphylococcal Pneumonia in a Neonate
September 15th 2006A 19-day-old infant was brought to the emergency department (ED) after a day of fever, coughing, and difficulty in breathing. He had been born at full term via vaginal delivery. There was no history of prolonged rupture of membranes. The mother was group B streptococcus-positive and had been treated appropriately before the delivery. The infant received 48 hours of empiric antibiotic therapy after his birth; blood cultures were negative at the birth hospital. The infant had been doing well before the ED visit.
Methicillin-Resistant Staphylococcal Pneumonia: Mortal Threat in a Neonate
September 15th 2006Staphylococcal pneumonia can be classified as either primary or secondary. In primary disease, the infection is caused by direct inoculation of the respiratory tract. Secondary disease occurs by hematogenous spread (eg, as in endocarditis).
Flu Viruses Hitch Rides on Jetliners
September 12th 2006BOSTON -- The sharp drop in air travel after the 9/11 attacks in 2001 slowed the spread of the 2001-2002 seasonal flu and delayed its peak by almost two weeks, according to researchers here. The finding showed that air travel contributes to influenza's spread.