A critical review of the quality of cough clinical practice guidelines.

Chest. 2016 May 6;

Authors: Jiang M, Guan WJ, Fang ZF, Xie YQ, Xie JX, Chen H, Wei D, Lai KF, Zhong NS

Abstract
BACKGROUND: Clinical practice guidelines (CPGs) have been developed to provide healthcare practitioners with the best possible evidence, but their quality varies greatly.
OBJECTIVE: To systematically evaluate the quality of cough CPGs and identify gaps limiting evidence-based practice.
METHODS: Systematic searches were conducted to identify cough CPGs in guideline databases, developers' websites and MEDLINE. Four reviewers independently evaluated eligible guidelines using Appraisal of Guidelines for Research and Evaluation II (AGREE II). Agreement among reviewers was assessed by intra-class correlation coefficient. The number of recommendations, strength of recommendation, and levels of evidence were determined.
RESULTS: Fifteen cough CPGs were identified. An overall high-degree agreement among reviewers was observed (intra-class correlation coefficient: 0.82; 95% confidence interval: 0.79-0.85). The quality ranged from good to acceptable in scope and purpose (mean: 72%, range: 54-93%) and clarity and presentation domains (mean: 68%, range: 50-90%), but not in stakeholder involvement (mean: 36%, range: 18-90%), rigour of development (mean: 36%, range: 9-93%), applicability (mean: 23%, range: 9-83%) and editorial independence domains (mean: 24%, range: 0-96%). Seven guidelines (46.7%) were considered 'strongly recommended' or 'recommended with modifications' for clinical practice. More than 70% of recommendations were based on non-randomized studies (level C, 30.4%) and expert opinion (level D, 41.3%).
CONCLUSIONS: The quality of cough CPGs is variable and recommendations are largely based on low-quality evidence. There is a significant room for improvement to develop high-quality guidelines, which urgently warrants high-quality researches to minimize the vital gaps in the evidence for formulation of cough CPGs.

PMID: 27164291 [PubMed - as supplied by publisher]

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A Compendium for Mycoplasma pneumoniae.

Front Microbiol. 2016;7:513

Authors: Parrott GL, Kinjo T, Fujita J

Abstract
Historically, atypical pneumonia was a term used to describe an unusual presentation of pneumonia. Currently, it is used to describe the multitude of symptoms juxtaposing the classic symptoms found in cases of pneumococcal pneumonia. Specifically, atypical pneumonia is a syndrome resulting from a relatively common group of pathogens including Chlamydophila sp., and Mycoplasma pneumoniae. The incidence of M. pneumoniae pneumonia in adults is less than the burden experienced by children. Transmission rates among families indicate children may act as a reservoir and maintain contagiousness over a long period of time ranging from months to years. In adults, M. pneumoniae typically produces a mild, "walking" pneumonia and is considered to be one of the causes of persistent cough in patients. M. pneumoniae has also been shown to trigger the exacerbation of other lung diseases. It has been repeatedly detected in patients with bronchitis, asthma, chronic obstructive pulmonary disorder, and cystic fibrosis. Recent advances in technology allow for the rapid diagnosis of M. pneumoniae through the use of polymerase chain reaction or rapid antigen tests. With this, more effort has been afforded to identify the causative etiologic agent in all cases of pneumonia. However, previous practices, including the overprescribing of macrolide treatment in China and Japan, have created increased incidence of macrolide-resistant M. pneumoniae. Reports from these countries indicate that >85% of M. pneumoniae pneumonia pediatric cases are macrolide-resistant. Despite its extensively studied past, the smallest bacterial species still inspires some of the largest questions. The developments in microbiology, diagnostic features and techniques, epidemiology, treatment and vaccines, and upper respiratory conditions associated with M. pneumoniae in adult populations are included within this review.

PMID: 27148202 [PubMed]

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Endogenous and Exogenous Stem/Progenitor Cells in the Lung and Their Role in the Pathogenesis and Treatment of Pediatric Lung Disease.

Front Pediatr. 2016;4:36

Authors: Leibel S, Post M

Abstract
The lung is a complex organ with a vast surface area whose main function is to release cellular waste to be exhaled and to replenish the supply of oxygen to the tissues of the body. The conduction of air from the external environment is not without risks, and the lung contains many specialized epithelial cell subtypes that are protecting the lung from foreign material and injury. Specialized cell subtypes are produced during lung development in the fetus as well as postnatally and injury to them due to genetic disease, premature birth, or postnatal environmental injury may lead to devastating disease. Chronic diseases, such as bronchopulmonary dysplasia, cystic fibrosis, and pulmonary arterial hypertension, contribute significantly to morbidity and mortality worldwide, yet successful interventions are often limited. Stem/progenitor cells have emerged as a potentially new preventative or therapeutic option. They are generally defined by the ability to undergo self-renewal and give rise to more differentiated cells. They are important in the early development of embryonic structures and organ differentiation in utero. Postnatally, they function in continued growth, maintenance, and regeneration. Clinically, the immunomodulatory properties of some classes of stem/progenitor cells avoid the major obstacle of immunological rejection seen in organ transplantation and other cell therapies. This review highlights some known human progenitor/stem cells and the most recent advances in stem cell therapies both in vivo and in vitro to prevent and treat pediatric lung disease.

PMID: 27148506 [PubMed]

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Prevalence of overlap syndrome in chronic obstructive pulmonary disease patients without sleep apnea symptoms.

Clin Respir J. 2016 May 5;

Authors: Basoglu OK, Gunduz C, Tasbakan MS

Abstract
BACKGROUND: The co-existence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) is a common phenomenon referred to as overlap syndrome (OS). In the present study, we evaluated the prevalence of OS in mild hypoxemic COPD patients without OSA symptoms and compared characteristics of OS and COPD patients.
METHODS: Forty five COPD patients (mean FEV1 1671.3±532.0 ml) with mild hypoxemia presenting no sleep apnea symptoms (96% men, mean age 67.7±8.5 years) were involved in this study. Clinical characteristics were recorded, biochemical analysis and polygraphy were performed.
RESULTS: Twenty-six patients with a RDI of ≥15 events/h were defined as OS (58%). When OS (n=26) and COPD without OSA (n=19) groups were compared, BMI (29.6±6.6 vs. 25.6±4.9kg/m(2) ; p=0.03), TNF-α level (24.8±8.1 vs. 3.6±0.8 ng/ml; p=0.03) and sleep time with SpO2 <90% (23.9±29.4 vs. 9.7±21.9%; p=0.02) were significantly increased in OS. Univariate analysis showed a correlation between RDI and BMI (p<0.01), Epworth score (p=0.050), COPD exacerbation frequency (p=0.046) and TNF-α (p=0.048). However, multivariate linear regression analysis revealed a significant correlation only between RDI and BMI (p<0.01). BMI as a predictor of OSA was examined through ROC curve analysis and the area under curve was 0.691 (p=0.03). To identify OS patients, BMI>27.2 kg/m(2) had a sensitivity of 73% and specificity of 68%.
CONCLUSIONS: The present findings support that high prevalence (58%) of OS in COPD patients without OSA symptoms is related to BMI. Therefore, sleep study should be considered in especially overweight or obese COPD patients, even in those without sleep apnea symptoms. This article is protected by copyright. All rights reserved.

PMID: 27148977 [PubMed - as supplied by publisher]