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CT-diagnosed emphysema and prognosis of chronic airflow obstruction: a retrospective study.

BMJ Open. 2013;3(11):e003541

Authors: Kurashima K, Fukuda C, Nakamoto K, Takaku Y, Hijikata N, Hoshi T, Kanauchi T, Ueda M, Takayanagi N, Sugita Y, Araki R

Abstract
OBJECTIVE: CT-diagnosed emphysema is associated with poor prognosis in chronic obstructive pulmonary disease (COPD). Its clinical impacts on prognoses of asthma with chronic airflow obstruction (CAO) are not well known. We sought to compare mortalities and prognostic factors in COPD and asthma with CAO by the presence or absence of CT-diagnosed emphysema.
DESIGN: Retrospective cohort study.
SETTING: Referral centre hospital for respiratory disease.
PARTICIPANTS: 1272 patients aged over 40 years with CAO (January 2000 to December 2011). CAO was defined as a forced expiratory volume in 1 s/forced vital capacity <0.7 after bronchodilator use throughout the observation period.
PRIMARY AND SECONDARY OUTCOME MEASUREMENTS: Overall mortality served as the primary endpoint. We compared mortalities and prognostic factors of COPD and asthma subgroups with or without emphysema. Secondary endpoints were the prevalence of COPD and asthma in patients with CAO.
RESULTS: Overall, diagnoses included COPD with emphysema in 517 (40.6%) patients, COPD without emphysema in 104 (8.2%) patients, asthma with emphysema in 178 (13.9%) patients, asthma without emphysema in 169 (13.3%) patients, other respiratory diseases (RD) with emphysema in 128 (10.1%) patients, and other RD without emphysema in 176 (13.8%) patients. Patients with asthma without emphysema had the best prognosis followed by those with asthma with emphysema, COPD without emphysema and COPD with emphysema. Each subgroup had distinct prognostic factors. Presence of emphysema was an independent risk factor for de novo lung cancer among patients with CAO.
CONCLUSIONS: Patients with asthma with CAO have a better prognosis than patients with COPD. The presence of CT-diagnosed emphysema predicts poor prognosis in COPD and asthma with CAO.

PMID: 24189080 [PubMed]

Adverse effects of long-term azithromycin use in patients with chronic lung diseases: A meta-analysis.

Antimicrob Agents Chemother. 2013 Nov 4;

Authors: Li H, Liu DH, Chen LL, Zhao Q, Yu YZ, Ding JJ, Miao LY, Xiao YL, Cai HR, Zhang DP, Guo YB, Xie CM

Abstract
The adverse effects of azithromycin on the treatment of patients with chronic lung diseases (CLD) were evaluated in the present study.MEDLINE, and other databases were searched for relevant articles till August 2013. Randomized controlled trials enrolled patients with chronic lung diseases who received long-term azithromycin treatment were selected and data on microbiological study and azithromycin-related adverse events were abstracted from articles and analyzed.Six studies were included in the meta-analysis. The risk of bacteria resistance in patients receiving long-term azithromycin treatment was increased 2.7-fold [RR: 2.69 (95% CI 1.249, 5.211)] when compared with patients with placebo treatment. On the opposite, the risk of bacteria colonization in patients receiving azithromycin treatment decreased [RR: 0.551 (95% CI 0.460, 0.658)]. Patients with long-term azithromycin therapy were at risk of increased impairment of hearing [RR: 1.168 (95% CI 1.030, 1.325)].This analysis provides evidence that supports the development of bacteria resistance after receiving long-term azithromycin treatment. Besides the increasingly recognized anti-inflammatory role of azithromycin used in chronic lung diseases, we should be realized the potential adverse event of its long-term use.

PMID: 24189261 [PubMed - as supplied by publisher]

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Influenza vaccines and Guillain-Barre syndrome: The continuing question.

Neurology. 2013 Oct 29;81(18):1562-3

Authors: Sejvar JJ

Abstract
Influenza is a global public health problem, with complications of seasonal influenza resulting in thousands of deaths and substantial morbidity worldwide. Periodically, particularly virulent viral strains emerge, resulting in more infections and fatalities (e.g., influenza A [H1N1] virus and influenza A/H5N1, "bird flu"). Influenza infection may be prevented or mitigated by vaccination; seasonal vaccine is highly effective in reducing clinical illness and limiting viral spread through respiratory droplets.

PMID: 24166961 [PubMed - in process]

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Impact of Unlabeled French Antibiotic Guidelines on Antibiotic Prescriptions for Acute Respiratory Tract Infections in Seven Pediatric Emergency Departments, 2009-2012.

Pediatr Infect Dis J. 2013 Oct 28;

Authors: Angoulvant F, Pereira M, Perreaux F, Soussan V, Pham LL, Trieu TV, Cojocaru B, Guedj R, Cohen R, Alberti C, Gajdos V

Abstract
From November 2009 to October 2012, implementation of guidelines, unlabeled by the French Agency of Health Products, changed the categories of antibiotics prescribed for acute respiratory tract infections (ARTI) in seven pediatric emergency departments. During the study, 36,413 ARTI-related antibiotic prescriptions were prescribed. Amoxicillin prescriptions rose from 30.0% to 84.7%, while amoxicillin-clavulanate and cefpodoxime prescriptions decreased to 10.2% and 2.5%, respectively.

PMID: 24168976 [PubMed - as supplied by publisher]