Chest Medicine
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)
AHA Scientific Statement | Evaluation and management of pulmonary hypertension in noncardiac surgery
17 Mar, 2023 | 13:12h | UTCTop Things to Know: Evaluation and Management of Pulmonary HTN in Non-Cardiac Surgery – American Heart Association
Cohort Study | COVID-19 outpatients mostly at low risk for VTE, but age, being male, and obesity are risk factors
17 Mar, 2023 | 13:11h | UTCSummary: The article discusses a cohort study that aimed to assess the risk of venous thromboembolism (VTE) among outpatients with COVID-19 and identify independent predictors of VTE.
The study used data from two integrated healthcare delivery systems in California and included 398.530 nonhospitalized adults aged 18 years or older with COVID-19 diagnosed between January 1, 2020, and January 31, 2021, with follow-up through February 28, 2021.
The results showed that the overall risk of VTE among outpatients with COVID-19 is low, but higher in the first 30 days after diagnosis. Factors associated with a higher risk of VTE in COVID-19 outpatients included:
- Age 55 years or older.
- Being male.
- history of VTE or thrombophilia.
- Body mass index greater than or equal to 30.0.
The study’s results could inform future randomized trials to explore targeted VTE preventive strategies and more intensive short-term surveillance for patients with COVID-19 who are at a higher risk of developing VTE.
Commentary: Venous blood clots rare among COVID-19 outpatients, study finds – CIDRAP
Commentary on Twitter
The rate of VTE was low in outpatients with #COVID19 in the first 30 days, and even lower >30 days. Factors associated with a higher risk of VTE in included age ≥55, male, prior VTE/thrombophilia, and BMI ≥30. https://t.co/3hwfDW88k4
— JAMA Network Open (@JAMANetworkOpen) March 13, 2023
Cohort Study | Leukotriene-receptor antagonist use during pregnancy not linked to neuropsychiatric events in offspring
17 Mar, 2023 | 12:56h | UTCCommentary: In utero exposure to asthma medication not tied to risks of neurodevelopmental disorders – MDedge
ACCP Guidelines | Respiratory management of patients with neuromuscular weakness
15 Mar, 2023 | 15:16h | UTC
M-A | Pretest probability assessment and D-Dimer are preferred for the initial evaluation of suspected PE in pregnant women
15 Mar, 2023 | 14:50h | UTC
RCT | Sotatercept improves exercise capacity in patients with pulmonary arterial hypertension
14 Mar, 2023 | 14:02h | UTCSummary: This multicenter, double-blind randomized trial involved 323 adults with Pulmonary Arterial Hypertension (PAH) who were randomized to receive either subcutaneous sotatercept or placebo every three weeks for 24 weeks.
The primary endpoint was the change from baseline in the 6-minute walk distance. Sotatercept demonstrated a greater improvement in exercise capacity compared to placebo and improved secondary endpoints, including pulmonary vascular resistance and WHO functional class.
Adverse events were more common in the sotatercept group and included epistaxis, dizziness, telangiectasia, increased hemoglobin levels, thrombocytopenia, and increased blood pressure.
Article: Phase 3 Trial of Sotatercept for Treatment of Pulmonary Arterial Hypertension – New England Journal of Medicine (link to abstract – $ for full-text)
Commentaries:
STELLAR, ‘Impressive’ Results With Novel Drug Sotatercept in PAH – TCTMD
Review | Role of precision medicine in obstructive sleep apnea
14 Mar, 2023 | 13:28h | UTCRole of precision medicine in obstructive sleep apnoea – BMJ Medicine
Commentary on Twitter
#Review: Role of precision medicine in obstructive sleep #apnoea ▶️https://t.co/OnxOHR2F6T#BMJMedicine pic.twitter.com/GUT3dKkfvL
— BMJMedicine (@BMJMedicine) March 9, 2023
Review | Guideline-based management of acute respiratory failure and acute respiratory distress syndrome
14 Mar, 2023 | 13:17h | UTC
Review | Commonly missed findings on chest radiographs: causes and consequences
13 Mar, 2023 | 15:07h | UTCCommonly Missed Findings on Chest Radiographs: Causes and Consequences – CHEST (free for a limited period)
See also: Reducing Errors Resulting From Commonly Missed Chest Radiography Findings – CHEST (free for a limited period)
Review | Reducing errors resulting from commonly missed chest radiography findings
13 Mar, 2023 | 15:06h | UTCReducing Errors Resulting From Commonly Missed Chest Radiography Findings – CHEST (free for a limited period)
See also: Commonly Missed Findings on Chest Radiographs: Causes and Consequences – CHEST (free for a limited period)
M-A | Routine anaerobic coverage for aspiration pneumonia: limited evidence of benefit
13 Mar, 2023 | 15:03h | UTCSummary: Treating aspiration pneumonia with antibiotics that cover anaerobic bacteria has become common practice in many services, but recent studies suggest that this may not necessarily improve prognosis.
Out of 2523 publications, this systematic review and meta-analysis only included one randomized control trial and two observational studies. The study found no clear benefit of anaerobic coverage and concluded that there is not enough data to evaluate the necessity of anaerobic coverage in the antibiotic treatment of aspiration pneumonia.
The authors suggest that covering anaerobic bacteria with antibiotics may not be needed as an initial treatment for aspiration pneumonia if there is no formation of abscess or empyema and the patient has good oral hygiene.
Related: BTS clinical statement on aspiration pneumonia – Thorax
M-A | Strength of association between comorbidities and asthma
13 Mar, 2023 | 15:01h | UTCSummary: The study investigated the strength of association between comorbidities and asthma, as the presence of comorbidities is related to poor asthma outcomes. A comprehensive literature search was conducted for observational studies reporting data on comorbidities in asthma and nonasthma populations.
A total of 5,493,776 subjects were analyzed, and several comorbidities were found to be strongly or very strongly associated with asthma and severe asthma, including allergic conjunctivitis, allergic rhinitis, bronchiectasis, hypertensive cardiomyopathy, nasal congestion, COPD, and other chronic respiratory diseases.
The study supports the relevance of individualized strategies for disease management that look beyond asthma and suggests a comprehensive approach should be used to assess whether poor symptom control is related to uncontrolled asthma or other underlying comorbidities.