Respiratory Diseases

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)

The association between asthma and pneumococcal disease has been suspected by many clinicians; however, formal investigations confirming an increased risk of pneumococcal disease in patients with asthma are rare. Often, studies examining risk factors for pneumococcal disease have grouped all chronic pulmonary diseases together with no delineation of the specific type of underlying disease.

Q:What is the best and most efficient method ofevaluating pulmonary function in primary careoffice practice?

Abstract: Smoking cessation is still the most important intervention in patients with chronic obstructive pulmonary disease (COPD), regardless of sex. There is some evidence that nicotine replacement therapy may be less effective in women than in men. However, women may derive greater benefits from a sustained quit attempt. For example, one study found that compared with men, women who were sustained quitters had a greater initial rise and a slower age-related decline in forced expiratory volume in 1 second. Men and women do not appear to differ in their response to bupropion or to the various types of bronchodilators. A number of factors contribute to the increased risk of osteoporosis in women with COPD. Both smoking and the degree of airflow obstruction have been identified as important risk factors for osteoporosis. Women may be particularly susceptible to the effects of smoking on bone metabolism. Immobility and decreased physical activity have also been shown to accelerate bone loss. (J Respir Dis. 2006;27(3):115-122)

Abstract: Inhalation of Aspergillus is responsible for a variety of lung infections and diseases; Aspergillus fumigatus is the most common causative agent. Allergic bronchopulmonary aspergillosis (ABPA), caused by sensitivity to A fumigatus, is diagnosed primarily in persons with asthma or cystic fibrosis. Differentiating ABPA from other Aspergillus-related lung infections and diseases is often challenging. A patient's symptoms, underlying risk factors, and any prior pulmonary disease contribute to the diagnosis. Findings include pulmonary infiltrates, total serum IgE levels greater than 1000 IU/mL, IgE and IgA anti-A fumigatus antibodies, peripheral blood and pulmonary eosinophilia, and central bronchiectasis. Untreated ABPA often results in chronic bronchiectasis, pulmonary fibrosis, and dependence on corticosteroids; an accurate diagnosis of ABPA is critical to avoiding irreparable disease. (J Respir Dis. 2006;27(3):123-134)

New recommendations for the treatment of coughs caused by colds and for the vaccination of adults against pertussis are among the changes in the revised guidelines on the mangement of coughs.

Some epidemiologic studies haveindicated that increased consumptionof margarine is a risk factor foratopy in children. Now, Nagel andLinseisen report that a high intakeof margarine is associated with anincreased risk of the developmentof adult-onset asthma.

A number of studies have found an increased prevalence of anxiety and depression in patients with asthma and chronic obstructive pulmonary disease (COPD). Although the relationship is not completely understood, it is clear that psychological disorders can adversely affect the course of both diseases.

Abstract: In the assessment of community-acquired pneumonia, an effort should be made to identify the causal pathogen, since this may permit more focused treatment. However, diagnostic testing should not delay appropriate empiric therapy. The selection of empiric therapy can be guided by a patient stratification system that is based on the severity of illness and underlying risk factors for specific pathogens. For example, outpatients who do not have underlying cardiopulmonary disease or other risk factors can be given azithromycin, clarithromycin, or doxycycline. Higher-risk outpatients should be given a ß-lactam antibiotic plus azithromycin, clarithromycin, or doxycycline, or monotherapy with a fluoroquinolone. If the patient fails to respond to therapy, it may be necessary to do bronchoscopy; CT of the chest; or serologic testing for Legionella species, Mycoplasma pneumoniae, viruses, or other pathogens. (J Respir Dis. 2006;27(2):54-67)