Chest Medicine (all articles)
Lateral flow devices maintain detection sensitivity across Alpha, Delta, and Omicron waves
3 Apr, 2023 | 13:53h | UTCSummary: The study assessed the performance of antigen lateral flow devices (LFDs) during the alpha, delta, and omicron waves of the SARS-CoV-2 pandemic in the UK. Researchers aimed to understand LFD performance concerning changes in variant infections, vaccination, viral load, and LFD use, as well as the devices’ ability to detect infectious individuals. Paired LFD and RT-PCR test results were collected from both asymptomatic and symptomatic participants between November 2020 and March 2022.
When compared to RT-PCR testing, the overall LFD sensitivity was 63.2%, and specificity was 99.71%. The sensitivity was higher in symptomatic participants (68.7%) than in asymptomatic participants (52.8%). The study found that increased viral load was independently associated with a higher likelihood of being LFD positive. There was no evidence of a significant difference in LFD sensitivity between the alpha and delta variants, but sensitivity increased during the omicron wave. Vaccination status did not show an independent association with LFD sensitivity.
The study concluded that LFDs can detect most SARS-CoV-2 infections across different viral variants and during vaccine roll-out, contributing to reduced transmission risk. However, LFD performance is lower in asymptomatic individuals, which should be taken into account when designing testing programs.
Invited Commentary: The performance of rapid antigen tests against SARS-CoV-2 variants – The Lancet Infectious Diseases
Related:
Interpreting a lateral flow SARS-CoV-2 antigen test – The BMJ
M-A | Incidence and prognostic role of pleural effusion in patients with pulmonary embolism
31 Mar, 2023 | 13:40h | UTC
Cohort Study | Diffusing capacity strongly predicts all-cause mortality in individuals with COPD
31 Mar, 2023 | 13:31h | UTCDiffusing Capacity and Mortality in Chronic Obstructive Pulmonary Disease – Annals of the American Thoracic Society (link to abstract – $ for full-text)
Commentary: Diffusing capacity ‘strongly predicted’ mortality in COPD patients – Healio (free registration required)
Commentary on Twitter
Diffusing Capacity and Mortality in Chronic Obstructive Pulmonary Disease
? https://t.co/F5Hqkx65hn pic.twitter.com/up0psKKE3i
— Annals of the ATS (@AnnalsATS) January 10, 2023
Updated WHO Guidelines | COVID-19 boosters no longer routinely recommended for low-risk groups
30 Mar, 2023 | 14:33h | UTCSummary: The WHO’s Strategic Advisory Group of Experts on Immunization (SAGE) has revised its COVID-19 vaccination roadmap in light of the Omicron variant and widespread population immunity. The revised roadmap prioritizes protecting those at the highest risk of severe disease and death while maintaining resilient health systems. It introduces cost-effectiveness considerations for vaccinating lower-risk individuals, such as healthy children and adolescents, and presents revised booster dose recommendations.
Priority groups are categorized as high, medium, and low, based on factors like risk of severe disease and death. People in the high-priority group, consisting of older adults, individuals with significant comorbidities or immunocompromising conditions, pregnant persons, and frontline health workers, are advised to receive additional boosters 6 or 12 months after the last dose. The medium priority group, which includes healthy adults without comorbidities and children with comorbidities, is recommended to receive primary series and first booster doses. However, SAGE no longer routinely recommends additional boosters for this group due to limited public health gains.
For the low-priority group, encompassing healthy children and adolescents, vaccination decisions should take into account factors such as disease prevalence and cost-effectiveness. It is important to note that the public health benefits of vaccinating healthy children and adolescents are considerably lower compared to established essential vaccines for children, like rotavirus, measles, and pneumococcal conjugate vaccines.
News Release: SAGE updates COVID-19 vaccination guidance – World Health Organization
Commentaries:
No More COVID-19 Boosters for Healthy People, WHO Experts Recommend – Health Policy Watch
WHO vaccine advisers update COVID vaccine recommendations – CIDRAP
Study suggests no heightened death risk in young people with mRNA vaccines, but ChAdOx1 nCoV-19 vaccine linked to female cardiac deaths
30 Mar, 2023 | 14:28h | UTC
Commentary from the author on Twitter (thread – click for more)
Our latest @NatureComms research: Risk of death following COVID-19 vaccination or positive SARS-CoV-2 test in young people in England. Led by @Vnafilyan @kamleshkhunti @IsobelLWard et al. https://t.co/oxNdgEAflQ (1/3)
— Prof Amitava Banerjee? (@amibanerjee1) March 28, 2023
Review | Supplemental oxygen and noninvasive ventilation
29 Mar, 2023 | 13:18h | UTCSupplemental oxygen and noninvasive ventilation – European Respiratory Review
Consensus Paper | Diagnosis and treatment of anticancer drug-induced interstitial lung disease
29 Mar, 2023 | 13:04h | UTC
M-A | Risk factors associated with post−COVID-19 condition
28 Mar, 2023 | 15:07h | UTCCommentary:
Meta-analysis reveals risk, protective factors for long COVID – CIDRAP
Long Covid: University of East Anglia study finds women more likely affected – BBC
People who catch Omicron are less likely to get Long Covid
28 Mar, 2023 | 15:04h | UTCPeople who catch Omicron are less likely to get Long Covid – Science
M-A | The natural history of untreated pulmonary tuberculosis in adults
28 Mar, 2023 | 14:42h | UTCThe natural history of untreated pulmonary tuberculosis in adults: a systematic review and meta-analysis – The Lancet Respiratory Medicine (free registration required)
Commentary from the author on Twitter
Very excited to have this work released into the open on #WorldTBDay in @LancetRespirMed: we used historical data to study the natural history of untreated TB https://t.co/IijrKfs13N @alexsrichards @hanifesmail_tb @Rein_Houben 1/n
— Bianca Sossen (@bianca_sossen) March 24, 2023
Pulmonary hypertension | An update of Dx and Tx guidelines
28 Mar, 2023 | 14:32h | UTCPulmonary hypertension: An update of Dx and Tx guidelines – Journal of Family Practice
M-A | Examining shorter antibiotic treatment durations for community acquired pneumonia in adults
27 Mar, 2023 | 13:29h | UTCSummary: The systematic review and duration-effect meta-analysis included nine randomized trials with a total of 2,399 patients, analyzing antibiotic treatment durations for community-acquired pneumonia (CAP) in adults. The primary outcome was clinical improvement on day 15, with secondary outcomes including all-cause mortality, serious adverse events, and clinical improvement on day 30.
The study found that shorter treatment durations (3–9 days) were likely to be non-inferior to the standard 10-day treatment, and no significant difference in all-cause mortality or serious adverse events was observed. The study suggests that a 3–5 day treatment duration likely offers the optimal balance between efficacy and treatment burden if patients are clinically stable. However, the results are limited by the small number of included studies, the overall moderate-to-high risk of bias, and the varying severity of CAP among patients in the studies. Therefore, further research focusing on the shorter duration range is required.
Related:
SR | Post-tuberculosis sequelae in children and adolescents
27 Mar, 2023 | 13:16h | UTCPost-tuberculosis sequelae in children and adolescents: a systematic review – The Lancet Infectious Diseases (free registration required)
M-A | Completion, safety, and efficacy of tuberculosis preventive treatment regimens containing rifampicin or rifapentine
27 Mar, 2023 | 13:14h | UTCCompletion, safety, and efficacy of tuberculosis preventive treatment regimens containing rifampicin or rifapentine: an individual patient data network meta-analysis – The Lancet Respiratory Medicine (free registration required)
Invited Commentary: Shorter regimens for tuberculosis preventive treatment: piecing together the global implementation jigsaw – The Lancet Respiratory Medicine (free registration required)
Commentary on Twitter
NEW Research—3HP provided an increase in treatment completion vs 4R but was associated with a higher risk of adverse events. The trade-off between completion and safety must be considered when deciding TPT
From Prof Dick Menzies & colleagues#WorldTBDayhttps://t.co/UY7l9OuI03 pic.twitter.com/GoKnu9BXoi
— The Lancet Respiratory Medicine (@LancetRespirMed) March 24, 2023
Brief Review | Bronchodilators or inhaled corticosteroids for postinfectious cough
27 Mar, 2023 | 13:00h | UTCBronchodilators or inhaled corticosteroids for postinfectious cough – Canadian Family Physician
Review | Lung transplantation for COPD/pulmonary emphysema
27 Mar, 2023 | 12:58h | UTCLung transplantation for COPD/pulmonary emphysema – European Respiratory Review
Consensus Paper | Connective tissue disease-associated pulmonary arterial hypertension
24 Mar, 2023 | 13:06h | UTC
M-A | Prevalence, imaging patterns and risk factors of interstitial lung disease in connective tissue disease
24 Mar, 2023 | 13:02h | UTC
RCT | Hydrocortisone reduces mortality in severe community-acquired pneumonia
22 Mar, 2023 | 13:44h | UTCSummary: Practice-changing! In a phase 3, multicenter, double-blind, randomized controlled trial involving 800 patients with severe community-acquired pneumonia admitted to the ICU, hydrocortisone treatment was found to reduce the risk of death by day 28 compared to a placebo group. The hydrocortisone group had a 6.2% death rate, while the placebo group had an 11.9% death rate.
Hydrocortisone also led to fewer endotracheal intubations among patients not on mechanical ventilation at baseline and reduced the need for vasopressor therapy in patients not receiving it at baseline. There was no significant difference in hospital-acquired infections or gastrointestinal bleeding between the two groups, but patients in the hydrocortisone group required higher daily doses of insulin during the first week of treatment.
Article: Hydrocortisone in Severe Community-Acquired Pneumonia – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary: Steroid drug reduces death rate in severe pneumonia, study shows – STAT
Commentary on Twitter
In this randomized trial, hydrocortisone treatment decreased mortality among patients with severe community-acquire pneumonia in the ICU. https://t.co/DZadFMcA5o#ISICEM23 pic.twitter.com/yhkVCjBMWX
— NEJM (@NEJM) March 21, 2023
Mechanical power of ventilation and driving pressure: two undervalued parameters for pre ECMO ventilation and during daily management?
22 Mar, 2023 | 13:24h | UTCRelated: Brief Review | Mechanical power: meaning, uses and limitations
RCT | Electronic nudges resulted in modest increase in influenza vaccination uptake in older adults
22 Mar, 2023 | 13:10h | UTCElectronic nudges to increase influenza vaccination uptake in Denmark: a nationwide, pragmatic, registry-based, randomised implementation trial – The Lancet (link to abstract – $ for full-text)
News Release: Electronic Messages Improved Influenza Vaccination Rates in Nationwide Danish Study – Brigham and Women’s Hospital
Commentary: Linking Flu Vaccine to Cardiovascular Benefit Could Increase Uptake in Older Adults – HCP Live
Review | Enhanced recovery after surgery and chest tube management
21 Mar, 2023 | 13:26h | UTCEnhanced recovery after surgery and chest tube management – Journal of Thoracic Disease
Related:
Cohort Study | Early childhood respiratory infections linked to increased risk of premature respiratory disease mortality in adulthood
20 Mar, 2023 | 13:52h | UTCSummary: The study aimed to determine the link between lower respiratory tract infections (LRTIs) in early childhood and premature adult death from respiratory disease. The study used data from a nationally representative cohort recruited at birth in Great Britain in 1946 and followed participants across eight decades.
After adjusting for multiple markers of childhood social disadvantage and adult smoking, the study found that individuals who had an LRTI by age 2 years were 93% more likely to die prematurely from respiratory disease as adults than those who did not have early childhood LRTI, accounting for one-fifth of these deaths and an estimated 179,188 excess deaths across England and Wales between 1972 and 2019.
However, it is important to note that this observational study cannot establish causality, but rather suggests that early childhood LRTI is a marker of increased risk of respiratory-cause deaths later in life.
News Release: Respiratory disease in early childhood linked to higher risk of death for adults – Imperial College London
Commentaries:
Childhood bronchitis, pneumonia tied to premature respiratory death in adults – CIDRAP
Early childhood lower respiratory tract infection: a key determinant of premature adult respiratory mortality – The Lancet (free registration required)
Commentary from the author on Twitter (thread – click for more)
1/ Great to see the interest in our @TheLancet paper linking lower respiratory tract infections in early childhood to the risk of premature adult death from respiratory disease across Great Britain.
A?exploring our study (1/21)
Full paper link below:https://t.co/LlGQJC1wAP
— James P Allinson (@JPAllinson) March 11, 2023
Perspective | Trials on oxygen targets in the critically ill patients: do they change our knowledge and practice?
20 Mar, 2023 | 13:26h | UTCTrials on oxygen targets in the critically ill patients: do they change our knowledge and practice? – Intensive Care Medicine (if the link is paywalled, try this one)
Commentary on Twitter
? Trials on liberal/conservative O2 targets in #ICU: conflicting results! Many studies in progress. Waiting for evidence, consider O2 as powerful drug to be carefully titrated, for most of critically ill pts in normoxia-mild hyperoxaemia range. #FOAMcc
?️ https://t.co/ECWgmQkmAZ pic.twitter.com/gIwB9ax0k1— Intensive Care Medicine (@yourICM) March 15, 2023
Brief Review | High-risk pulmonary embolism in the ICU
20 Mar, 2023 | 13:24h | UTCHigh-risk pulmonary embolism in the intensive care unit – Intensive Care Medicine (free for a limited period)