Respiratory Diseases

SAO PAULO, Brazil -- Women who are on long-term oxygen therapy for chronic obstructive pulmonary disease (COPD) are 54% more likely to die than men.

Previous receipt of the pneumococcal vaccine is associated with improved survival, reduced risk of respiratory failure, and decreased length of stay among patients hospitalized with community-acquired pneumonia (CAP). This finding was reported by Fisman and associates, who evaluated data from 109 community and teaching hospitals.

Increased attention is being given to the potential use of bronchial thermoplasty in the management of patients with asthma. This procedure uses radiofrequency ener- gy to reduce the mass of smooth muscle in the walls of conducting airways, thereby reducing the potential for smooth muscle-mediated bronchoconstriction. Is bronchial thermoplasty safe, and does it work? Yes, according to a study conducted in Canada by Cox and associates.

Abstract: A number of factors can contribute to a delay in the diagnosis of tuberculosis in pregnant women, including the presence of nonspecific symptoms, such as fatigue and cough; extrapulmonary manifestations; and asymptomatic disease. The diagnostic evaluation is the same as for nonpregnant patients and includes tuberculin skin testing and, when indicated, chest radiography (with appropriate shielding) and acid-fast bacillus stain and culture. Antituberculous therapy during pregnancy is generally safe and effective, although streptomycin should not be used because of the risk of vestibular or auditory damage to the fetus. For patients with active tuberculosis, treatment should be initiated as soon as the diagnosis is established. The treatment of latent infection is somewhat more controversial. The timing of the initiation of therapy is based on the risk of progression to active disease. (J Respir Dis. 2006;27(8):338-347)

Effective asthma control involves the assessment of symptoms, changes in pulmonary function, and effects on quality of life and functional ability. A 5-item, patient-administered survey, the Asthma Control Test (ACT), has been developed as an assessment tool (Table). Investigators evaluated the reliability and validity of the ACT in a longitudinal study of patients with asthma who were new to the care of an asthma specialist.

SACRAMENTO, Calif. -- Rescue inhalers for asthmatics don't keep track of bronchodilator doses used or remaining, leaving some patients in the lurch when they need the drugs most.

MADRID -- Lung function of Medicare-age patients, as measured by standard spirometry, can suggest how likely they are to develop dementia in the next five to six years, researchers reported here.

STANFORD, Calif -- Patients with chronic obstructive pulmonary disease (COPD) who used inhaled beta-2 agonists had more than twice the risk for respiratory death than those who used anticholinergic agents, according to investigators here.

NASHVILLE, Tenn. - Nearly one in every 1,000 pre-schoolers is hospitalized for influenza every year and the rate is more than four times higher for children six months or younger.

Abstract: Elderly persons with active tuberculosis may present with the classic features, such as cough, hemoptysis, and fever, but some patients present with less typical signs, such as hepatosplenomegaly, liver function abnormalities, and anemia. A high index of suspicion is required when a patient presents with cough or pneumonia unresponsive to conventional therapy. Acid-fast smear and mycobacterial culture of a sputum specimen are recommended for diagnosis. For an elderly patient who tests positive with purified protein derivative, 9 months of isoniazid prophylaxis is recommended. For patients who are intolerant of isoniazid or have been exposed to or infected by an isoniazid-resistant strain, rifampin single-agent preventive therapy may be an effective alternative. (J Respir Dis. 2006;27(7):307-315)

abstract: There is increasing evidence that close monitoring and early intervention lead to better outcomes in patients with cystic fibrosis. At each office visit, spirometry should be performed and sputum culture specimens should be obtained; if the patient cannot produce sputum, a throat culture can be done instead. New respiratory symptoms or other evidence of worsening lung disease should prompt antibiotic therapy, increased airway clearance, and adjunctive anti-inflammatory medication as appropriate. Close attention should be paid to the patient's diet, appetite, stooling pattern, and growth measurements. Adolescents should be given additional information about their medications and adjunctive therapies to encourage them to take on a larger role in their own care. (J Respir Dis.2006;27(7):298-305)

The American Academy of Allergy, Asthma, and Immunology (AAAAI) recently published guidelines for referring patients to an allergist/immunologist.1 The recommendations address topics such as rhinitis, asthma, cough, anaphylaxis, dermatitis, urticaria, and food allergy.

A review of the environmental determinants of allergic rhinitis and asthma, including house dust mites, cats, dogs, and cockroaches.

Although the relationship is not completely understood, it is clear that anxiety and depression can adversely affect the course of asthma and chronic obstructive pulmonary disease.

Avoidance of allergens and irritants known to cause or aggravate allergic rhinitis and asthma is a key component in the management of these disorders.

HINES, Ill. - Family physicians may be diagnosing chronic obstructive pulmonary disease (COPD) overly hastily, evaluating only symptoms and smoking history without the recommend spirometry to assess lung function, researchers here said.

LONDON, June 15 - Patients with cystic fibrosis can safely stop using inhaled corticosteroids, according to researchers here.

UTRECHT, The Netherlands - Oral swabbing with antiseptics may be an inexpensive and effective way to prevent bacterial pneumonia in patients on mechanical ventilators, according to a study here.

DEVON, England - Middle-age smokers with heavily wrinkled faces are five times likelier to develop chronic obstructive pulmonary disease (COPD) than smooth-faced smokers, according to researchers here.

AMSTERDAM, The Netherlands ? A short course of antibiotics is just as effective as seven to 10 days for patients with uncomplicated community-acquired pneumonia who improve substantially, researchers here reported.

HAMILTON, Ontario ? A more intensive program of treating pneumonia in nursing home residents can keep many of them out the hospital, researchers here said.

Abstract: A number of factors can complicate the diagnosis of asthma in elderly patients. For example, the elderly are more likely to have diseases such as chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) that--like asthma--can cause cough, dyspnea, and wheezing. Spirometry can help distinguish asthma from COPD, and chest radiography and measurement of brain natriuretic peptide levels can help identify CHF. Important considerations in the management of asthma include drug side effects, drug interactions, and difficulty in using metered-dose inhalers. When discussing the goals of therapy with the patient, remember that quality-of-life issues, such as the ability to live independently and to participate in leisure activities, can be stronger motivators than objective measures of pulmonary function. (J Respir Dis. 2006;27(6):238-247)

ANN ARBOR, Mich. - Even if there were a foolproof vaccine against avian flu, but with a small risk or mortality from the vaccine itself, many people would take their chances with the virus.

CHAPEL HILL, N.C. - Inhaled corticosteroids reduce exacerbations with acceptable side effects in patients with moderate or severe COPD, but not mild disease, shows a meta-analysis.

Abstract: Exercise intolerance is common in persons with chronic obstructive pulmonary disease and can result from multiple physiologic factors, including dynamic hyperinflation, gas exchange abnormalities, and pulmonary hypertension. In the initial assessment, keep in mind that many patients underestimate the degree of their impairment. The 6-minute walk test is very useful in assessing the degree of exercise intolerance; when more extensive assessment is indicated, cardiopulmonary exercise testing (CPET) is the gold standard. CPET is particularly useful for defining the underlying physiology of exercise limitation and may reveal other causes of dyspnea, such as myocardial ischemia or pulmonary hypertension. Strategies for improving exercise tolerance range from the use of bronchodilators and supplemental oxygen to participation in a pulmonary rehabilitation program. (J Respir Dis. 2006;27(5):208-218)

Initiation of early aggressive therapy is critical to averting fatal outcomes in exacerbations of acute life-threatening asthma.

The morbidity and mortality of asthma can be reduced by identifying high-risk patients, using objective and subjective measures to detect severe exacerbations, and initiating early medical intervention.

Q:What constitutes the optimal management of asthma ina pregnant patient?

Guidelines for the management of community-acquired pneumonia (CAP) have been published by several medical organizations, including the British Thoracic Society, the American Thoracic Society, and the Infectious Diseases Society of America (IDSA). Do these guidelines help improve survival rates? Yes, according to a study that focused on adherence to the IDSA guidelines and outcomes for patients with severe CAP. This study also underscores the importance of providing adequate coverage for Pseudomonas aeruginosa in patients with risk factors such as chronic obstructive pulmonary disease (COPD), malignancy, or recent antibiotic treatment.

Abstract: Multidrug-resistant tuberculosis is defined as tuberculosis caused by strains that have documented in vitro resistance to isoniazid and rifampin. Treatment involves a regimen consisting of at least 4 or 5 drugs to which the infecting strain has documented susceptibility. These agents may include ethambutol, pyrazinamide, streptomycin, a fluoroquinolone, ethionamide, prothionamide, cycloserine, and para-aminosalicylic acid. In addition, an injectable agent, such as kanamycin, amikacin, or capreomycin, should be used until negative sputum cultures have been documented for at least 6 months. If the patient has severe parenchymal damage, high-grade resistance, or clinically advanced disease, also consider clofazimine, amoxicillin/clavulanate, or clarithromycin, although there is little evidence supporting their efficacy in this setting. Routine monitoring includes monthly sputum smear and culture testing, monthly assessment of renal function and electrolyte levels, and liver function tests every 3 to 6 months. (J Respir Dis. 2006;27(4):172-182)