Inhaled corticosteroid use in patients with chronic obstructive pulmonary disease and the risk of pneumonia: a retrospective claims data analysis.

Int J Chron Obstruct Pulmon Dis. 2013;8:295-304

Authors: Yawn BP, Li Y, Tian H, Zhang J, Arcona S, Kahler KH

Abstract
BACKGROUND: The use of inhaled corticosteroids in patients with chronic obstructive pulmonary disease (COPD) has been associated with an increased risk of pneumonia in controlled clinical trials and case-control analyses.
OBJECTIVE: Using claims databases as a research model of real-world diagnosis and treatment, to determine if the use and dose of inhaled corticosteroids (ICS) among patients with newly diagnosed COPD are associated with increased risk of pneumonia.
PATIENTS AND METHODS: This was a retrospective cohort analysis of patients diagnosed with COPD between January 01, 2006 and September 30, 2010, drawn from databases (years 2006-2010). Patients (aged ≥45 years) were followed until first pneumonia diagnosis, end of benefit enrollment, or December 31, 2010, whichever was earliest. A Cox proportional hazard model was used to assess the association of ICS use and risk of pneumonia, controlling for baseline characteristics. Daily ICS use was classified into low, medium, and high doses (1 μg-499 μg, 500 μg-999 μg, and ≥1000 μg fluticasone equivalents daily) and was modeled as a time-dependent variable.
RESULTS: Among 135,445 qualifying patients with a total of 243,097 person-years, there were 1020 pneumonia incidences out of 5677 person-years on ICS (crude incidence rate, 0.180 per person-year), and 27,730 pneumonia incidences out of 237,420 person-years not on ICS (crude incidence rate, 0.117 per person-year). ICS use was associated with a dose-related increase in risk of pneumonia, with adjusted hazard ratios (versus no use; (95% confidence interval) of 1.38 (1.27-1.49) for low-dose users, 1.69 (1.52-1.88) for medium-dose users, and 2.57 (1.98-3.33) for high-dose users (P < 0.01 versus no use and between doses).
CONCLUSION: The use of ICS in newly diagnosed patients with COPD is potentially associated with a dose-related increase in the risk of pneumonia.

PMID: 23836970 [PubMed - in process]

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Extended cervical mediastinoscopy revisited.

Eur J Cardiothorac Surg. 2013 Jun 25;

Authors: Witte B, Wolf M, Hillebrand H, Kriegel E, Huertgen M

Abstract
OBJECTIVES: To describe the diagnostic value of selective extended cervical mediastinoscopy (ECM) in combination with video-assisted mediastinoscopic lymphadenectomy (VAMLA) in mediastinal staging of potentially resectable left-sided lung carcinoma.
METHODS: Institutional report on 110 ECM procedures indicated for enlarged lymph nodes within the aorto-pulmonary (AP) zone on computed tomography. Staging sensitivity, negative predictive value (NPV) and specificity of ECM, combined VAMLA and ECM, VAMLA alone and systematic dissection for lung resection via left-sided video-assisted thoracoscopic surgery (VATS) or thoracotomy were calculated from a subset of 92 patients with left-sided lung carcinoma.
RESULTS: Selective ECM was performed in 12.6% of all video-mediastinoscopic procedures, and added, except for one vascular complication, there was no morbidity. ECM had an impact on mediastinal staging in 78.0% of the lung cancer cases. Sensitivity, NPV and specificity were 0.94, 0.96 and 1 for ECM to detect nodal involvement within the AP zone. Sensitivity, NPV and specificity to detect any mediastinal diseases were 0.94, 0.96 and 1 for the combination of ECM and VAMLA; 0.64, 0.80 and 1 for VAMLA alone and 0.76, 0.84 and 1 for systematic mediastinal dissection via left-sided VATS or thoracotomy approach.
CONCLUSIONS: ECM complements VAMLA in comprehensive mediastinal dissection. Selective ECM is a valuable addendum to mediastinoscopic staging procedures for left-sided tumours, as it enhances sensitivity and NPV. Precaution and experience are required to circumvent the rare risk of potentially fatal vascular accidents.

PMID: 23803515 [PubMed - as supplied by publisher]

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Lung ultrasound: its role in neonatology and pediatrics.

Early Hum Dev. 2013 Jun;89 Suppl 1:S17-9

Authors: Cattarossi L

Abstract
BACKGROUND: Lung ultrasound (LUS) has become more and more popular in the first decade of the 21(st) century, both in neonatal and in pediatric age groups. Several papers addressed the usefulness of this procedure mainly because of its possibility to be utilised at the bedside, without risk of irradiation along with simple and immediate interpretations of the images.
AIMS: The purpose of this paper is to update the knowledge on LUS related to the most common neonatal respiratory diseases and some pediatric acute lung diseases.
STUDY DESIGN: We describe the technique of LUS execution, the normal LUS appearance and the LUS findings in the most common neonatal and pediatric acute diseases.
SUBJECTS: LUS findings related to neonates of different gestational age as well as of pediatric patients from infancy to childhood are shown.
OUTCOME MEASURES: Issues on the evolution and effect of treatment related to LUS findings of neonatal and pediatric respiratory diseases are discussed.
RESULTS: LUS depicted peculiar and reproducible patterns in all the lung diseases described.
CONCLUSIONS: The use of LUS in the clinical field seems to be a reasonable and easy-to-use practice that can be considered an extension of the clinical exam. As a consequence of this feature, LUS, to fully express its potential, must be performed by the clinician in charge of the patient.

PMID: 23809341 [PubMed - in process]

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Pulmonary surfactant deficiency caused by mutations in ABCA3 (ATP-binding cassette transporter of the A subfamily, member 3) gene results in diffuse parenchymal lung disease (DPLD) in children. So far, systemic steroids are the main treatment, with however limited efficacy.

We report the case of a young boy showing a dramatic long-term improvement of respiratory disease by low-dose azithromycin (AZM) with no side effect after 6 years of treatment. Cellular and molecular studies are ongoing to progress in the understanding of the mechanisms involved. On behalf of the National Reference Center for rare lung diseases in France (Respirare, http://www.respirare.fr), clinical studies on AZM in various forms of DPLD in children have been initiated and should provide information on the types of paediatric DPLD that may benefit from this treatment.