Login to your account

Username *
Password *
Remember Me

Blog With Right Sidebar

    Vous êtes ici :  
  1. Accueil
  2. Blog With Right Sidebar

Severity and outcomes of community acquired pneumonia in asthmatic patients

Limited information is available about clinical outcomes and microbiology of community-acquired pneumonia in asthma.

Methods : We prospectively studied 4079 CAP patients over a 12-years period and found 139 (3.4%) asthmatic patients.

Results : Asthmatics showed younger age (57±19 vs. 66±19 years), less males (32% vs. 68%) and less active smokers (15% vs. 25%). Moreover, they had used more frequently inhaled corticosteroids (ICs, 53% vs. 17%, p<0.001) and antibiotics (32% vs. 24%, p=0.041). In comparison with non asthma-CAP, asthmatics showed at admission more pleuritic pain and dyspnoea but less severe pneumonia (PSI, CURB-65, PaO2/FiO2 ratio; p<0.05). No differences were observed in CAP microbiology, being Streptococcus pneumoniae the most frequent isolate. Clinical outcomes in asthmatic patients were similar to the general population (mortality, mechanical ventilation, etc.) but with a shorter median length of stay (6 [3; 9] vs. 7 [4; 10] days, p=0.023). The chronic use of ICs did not influence clinical presentation and outcomes among asthmatic patients.

Conclusions : Asthmatics were younger and showed similar clinical presentation. Consistently with PSI, asthmatics showed similar outcomes than the general population. The microbial aetiology of CAP in asthma did not differ from the general population and antibiotic therapy should follow current guidelines.

Clinical cure rates in subjects treated with azithromycin for community-acquired respiratory tract infections caused by azithromycin-susceptible or azithromycin-resistant Streptococcus pneumoniae: analysis of Phase 3 clinical trial data

Conclusions Clinical cure rates in CARTI subjects treated with azithromycin were higher for Azi-S SPN (89.4%) versus Azi-R SPN (78.6%; P = 0.003). However, cure rates were not different for subjects infected with LLAR-SPN versus HLAR-SPN. At the observed prevalence of Azi-R SPN of 28.9%, an additional 3.1 clinical failures would be predicted, as a consequence of azithromycin resistance (LLAR and HLAR), per 100 subjects treated empirically with azithromycin. (Source: Journal of Antimicrobial Chemotherapy)

Antibiotics Prescribed Nearly Twice as Often as Expected in Pediatric Acute Respiratory Infections (FREE)

Antimicrobial drugs are prescribed almost twice as often as expected to pediatric outpatients presenting with acute respiratory tract infections (ARTI) in the U.S., according to a Pediatrics study.

In a meta-analysis, researchers examined studies assessing the bacterial etiologies of ARTIs in children after the licensure of the pneumococcal conjugate vaccine in 2000. Bacteria were isolated in 65% of acute otitis media visits and 20% of pharyngitis visits. The overall estimated bacteria prevalence — and thus expected antimicrobial prescribing rate — for all ARTIs combined was 27%. However, a retrospective cohort analysis of children in ambulatory clinics found that antimicrobials were prescribed in 57% of ARTI visits.

The authors estimate that there are 11.4 million potentially avoidable prescriptions for antibiotics every year for ARTIs and conclude that this area represents "an important target for ongoing antimicrobial stewardship interventions."

Interstitial lung disease: raising the index of suspicion in primary care.

Interstitial lung disease (ILD) describes a group of diseases that cause progressive scarring of the lung tissue through inflammation and fibrosis. The most common form of ILD is idiopathic pulmonary fibrosis, which has a poor prognosis.

ILD is rare and mainly a disease of the middle-aged and elderly. The symptoms of ILD—chronic dyspnoea and cough—are easily confused with the symptoms of more common diseases, particularly chronic obstructive pulmonary disease and heart failure. ILD is infrequently seen in primary care and a precise diagnosis of these disorders can be challenging for physicians who rarely encounter them. Confirming a diagnosis of ILD requires specialist expertise and review of a high-resolution computed tomography scan (HRCT). Primary care physicians (PCPs) play a key role in facilitating the diagnosis of ILD by referring patients with concerning symptoms to a pulmonologist and, in some cases, by ordering HRCTs.

In our article, we highlight the importance of prompt diagnosis of ILD and describe the circumstances in which a PCP’s suspicion for ILD should be raised in a patient presenting with chronic dyspnoea on exertion, once more common causes of dyspnoea have been investigated and excluded.

Use of leukotriene receptor antagonists are associated with a similar risk of asthma exacerbations as inhaled corticosteroids.

Related Articles

Use of leukotriene receptor antagonists are associated with a similar risk of asthma exacerbations as inhaled corticosteroids.

J Allergy Clin Immunol Pract. 2014 Sep-Oct;2(5):607-13

Authors: Wu AC, Li L, Fung V, Kharbanda EO, Larkin EK, Vollmer WM, Butler MG, Miroshnik I, Rusinak D, Davis RL, Hartert T, Weiss ST, Lieu TA

Abstract
BACKGROUND: Based on results of clinical trials, inhaled corticosteroids (ICS) are the most-effective controller medications for preventing asthma-related exacerbations, yet few studies in real-life populations have evaluated the comparative effectiveness of ICS.
OBJECTIVE: To determine the likelihood of asthma exacerbations among children with asthma after initiation of controller medications: ICS, leukotriene antagonists (LTRA), and ICS-long-acting β-agonist (LABA) combination therapy.
METHODS: This was a retrospective cohort study of subjects who were part of the Population-Based Effectiveness in Asthma and Lung Diseases Network. We conducted Cox regression analyses by adjusting for baseline covariates, adherence by using proportion of days covered, and high-dimensional propensity scores. The main outcome measurements were emergency department visits, hospitalizations, or oral corticosteroid use.
RESULTS: Our population included 15,567 health plan subjects and 10,624 TennCare Medicaid subjects with uncontrolled asthma. Overall adherence to controller medications was low, with no more than 50% of the subjects refilling the medication after the initial fill. For subjects with allergic rhinitis, the subjects in TennCare Medicaid treated with LTRAs were less likely to experience ED visits (hazard ratio 0.44 [95% CI, 0.21-0.93]) compared with the subjects treated with ICS. For all other groups, the subjects treated with LTRA or ICS-LABA were just as likely to experience ED visits or hospitalizations, or need oral corticosteroids as the subjects treated with ICS.
CONCLUSION: Risks of asthma-related exacerbations did not differ between children who initiated LTRA and ICS. These findings may be explainable by LTRA, which has similar effectiveness as ICS in real-life usage by residual confounding by indication or other unmeasured factors.

PMID: 25213056 [PubMed - in process]

Search

Search