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Characteristics of Atopic Bronchial Asthma in Seniors over 80 Years of Age.

Biomed Res Int. 2013;2013:689782

Authors: Bożek A, Filipowski M, Fischer A, Jarzab J

Abstract
Background. Asthma in the elderly is an important public health problem. The aim of this study was to assess the prevalence and characteristics of asthma in seniors. Materials and Methods. The study involved 105 people of at least 80 years of age (mean age of 84.1 ± 3.9 years) selected from a group of 1860 individuals. Spirometry, the methacholine test, allergy diagnosis, a measurement of exhaled nitric oxide, and administration of the asthma quality of life questionnaire (AQLQ) were performed. Results. The average morbidity of asthma in the study population of elderly people (at least 80 years of age) was 5.6% (105 people) of the confidence interval (95% CI: 5.1-6.0). In the study group, 34% of the elderly asthmatics had uncontrolled asthma, 47% had partly controlled asthma, and only 24% had fully controlled asthma. Allergy to house dust mites was predominant. The average total score on the AQLQ was 4.12 ± 0.72 (arithmetic mean ± standard deviation) for the seniors, which was significantly lower than the score for the young. Conclusion. The pathogenesis, natural history, and value of the basic diagnostic methods of asthma in the elderly are similar to those observed in younger age groups.

PMID: 23984398 [PubMed - in process]

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EGFR mutational status in a large series of Caucasian European NSCLC patients: data from daily practice.

Br J Cancer. 2013 Sep 3;

Authors: Gahr S, Stoehr R, Geissinger E, Ficker JH, Brueckl WM, Gschwendtner A, Gattenloehner S, Fuchs FS, Schulz C, Rieker RJ, Hartmann A, Ruemmele P, Dietmaier W

Abstract
Background:The prognosis of metastatic non-small cell lung cancer (NSCLC) is still poor. Activating epithelial growth factor receptor (EGFR) mutations are important genetic alterations with dramatic therapeutical implications. Up to now, in contrast to Asian populations only limited data on the prevalence of those mutations are available from patients with Caucasian and especially European ethnicity.Methods:In this multicentre study, 1201 unselected NSCLC patients from Southern Germany were tested in the daily clinical routine for EGFR mutation status.Results:Activating EGFR mutations were found in 9.8% of all tumours. Mutations in exons 18, 19 and 21 accounted for 4.2%, 61.9% and 33.1% of all mutations, respectively. Non-smokers had a significantly higher rate of EGFR mutations than smokers or ex-smokers (24.4% vs 4.2%; P<0.001). Non-lepidic-non-mucinous adenocarcinomas (G2) accounted for 45.5% of all activating EGFR mutations and 3.5% of all squamous cell carcinomas were tested positive. Thyroid transcription factor 1 protein expression was significantly associated with EGFR mutational status.Conclusion:These comprehensive data from clinical routine in Germany add to the knowledge of clinical and histopathological factors associated with EGFR mutational status in NSCLC.British Journal of Cancer advance online publication, 3 September 2013; doi:10.1038/bjc.2013.511 www.bjcancer.com.

PMID: 24002608 [PubMed - as supplied by publisher]

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Procalcitonin-guided antibiotic therapy: A systematic review and meta-analysis.

J Hosp Med. 2013 Sep;8(9):530-40

Authors: Soni NJ, Samson DJ, Galaydick JL, Vats V, Huang ES, Aronson N, Pitrak DL

Abstract
BACKGROUND: The utility of procalcitonin to manage patients with infections is unclear. A systematic review of comparative studies using procalcitonin-guided antibiotic therapy in patients with infections was performed.
METHODS: Randomized, controlled trials comparing procalcitonin-guided initiation, intensification, or discontinuation of antibiotic therapy to clinically guided therapy were included. Outcomes were antibiotic usage, morbidity, and mortality. MEDLINE, EMBASE, the Cochrane Database, National Institute for Clinical Excellence, the National Guideline Clearinghouse, and the Health Technology Assessment Programme were searched from January 1, 1990 to December 16, 2011.
RESULTS: Eighteen randomized, controlled trials were included. Data were pooled into clinically similar patient populations. In adult intensive care unit (ICU) patients, procalcitonin-guided discontinuation of antibiotics reduced antibiotic duration by 2.05 days (95% confidence interval [CI]: -2.59 to -1.52) without increasing morbidity or mortality. In contrast, procalcitonin-guided intensification of antibiotics in adult ICU patients increased antibiotic usage and morbidity. In adult patients with respiratory tract infections, procalcitonin guidance significantly reduced antibiotic duration by 2.35 days (95% CI: -4.38 to -0.33), antibiotic prescription rate by 22% (95% CI: -41% to -4%), and total antibiotic exposure without affecting morbidity or mortality. A single, good quality study of neonates with suspected sepsis demonstrated reduced antibiotic duration by 22.4 hours (P = 0.012) and reduced the proportion of neonates on antibiotics for ≥72 hours by 27% (P = 0.002) with procalcitonin guidance.
CONCLUSION: Procalcitonin guidance can safely reduce antibiotic usage when used to discontinue antibiotic therapy in adult ICU patients and when used to initiate or discontinue antibiotics in adult patients with respiratory tract infections. Journal of Hospital Medicine 2013;8:530-540. © 2013 Society of Hospital Medicine.

PMID: 23955852 [PubMed - in process]

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Proximal and distal gastro-oesophageal reflux in COPD and bronchiectasis.

Respirology. 2013 Aug 27;

Authors: Lee AL, Button BM, Denehy L, Roberts SJ, Bamford TL, Ellis SJ, Mu FT, Heine RG, Stirling RG, Wilson JW

Abstract
BACKGROUND AND OBJECTIVE: The aims of this observational study were to (1) examine the prevalence of symptomatic and clinically silent proximal and distal gastro-oesophageal reflux (GOR) in adults with COPD or bronchiectasis, (2) the presence of gastric aspiration and (3) to explore the possible clinical significance of this co-morbidity in these conditions.
METHODS: 27 participants with COPD, 27 with bronchiectasis and 17 control subjects completed reflux symptom evaluation and dual-channel 24hr oesophageal pH monitoring. In those with lung disease, pepsin levels in sputum samples were measured using ELISA, with disease severity (lung function and high resolution computed tomography) also measured.
RESULTS: The prevalence of GOR in COPD was 37%; in bronchiectasis was 40% and in control subjects was 18% (p=0.005). Of those diagnosed with GOR, clinically silent reflux was detected in 20% of participants with COPD and 42% with bronchiectasis. While pepsin was found in 33% of COPD and 26% of bronchiectasis participants, the presence of pepsin in sputum was not related to a diagnosis of GOR based on oesophageal pH monitoring in either condition. Neither a diagnosis of GOR nor the presence of pepsin was associated with increased severity of lung disease in COPD or bronchiectasis.
CONCLUSIONS: The prevalence of GOR in COPD or bronchiectasis is twice that of the control population, and the diagnosis could not be based on symptoms alone. Pepsin was detected in sputum in COPD and bronchiectasis, suggesting a possible role of pulmonary aspiration which requires further exploration.

PMID: 24033416 [PubMed - as supplied by publisher]