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Statins and the risk of interstitial lung disease: a cohort study

Background

Case reports have suggested that the use of statins may be associated with an increase in the risk of interstitial lung disease (ILD).

 Methods

Within a large cohort of users of respiratory medications identified in the Quebec health administrative databases during 1990–2005, we carried out a nested case–control analysis of the relationship between statins and the risk of ILD as defined by specialist visits or hospitalisations.

 Results

The cohort included over 1.4 million patients, of which 6665 possible or probable cases of ILD were identified during follow-up. These were compared with 26 660 controls matched for age, gender and calendar time. After adjustment for confounders and comorbid conditions, there was no association between current use of statins and risk of ILD (adjusted OR 0.99, 95% CI 0.91 to 1.08). The results were similar when any use of statins within the previous 1 or 2 years was considered or when the analysis was limited to more definite cases.

 Conclusions

This large cohort study did not find an association between statin use and the incidence of ILD.

Do fast foods cause asthma, rhinoconjunctivitis and eczema? Global findings from the International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three

Background

Certain foods may increase or decrease the risk of developing asthma, rhinoconjunctivitis and eczema. We explored the impact of the intake of types of food on these diseases in Phase Three of the International Study of Asthma and Allergies in Childhood.

 Methods

Written questionnaires on the symptom prevalence of asthma, rhinoconjunctivitis and eczema and types and frequency of food intake over the past 12 months were completed by 13–14-year-old adolescents and by the parents/guardians of 6–7-year-old children. Prevalence ORs were estimated using logistic regression, adjusting for confounders, and using a random (mixed) effects model.

 Results

For adolescents and children, a potential protective effect on severe asthma was associated with consumption of fruit ≥3 times per week (OR 0.89, 95% CI 0.82 to 0.97; OR 0.86, 95% CI 0.76 to 0.97, respectively). An increased risk of severe asthma in adolescents and children was associated with the consumption of fast food ≥3 times per week (OR 1.39, 95% CI 1.30 to 1.49; OR 1.27, 95% CI 1.13 to 1.42, respectively), as well as an increased risk of severe rhinoconjunctivitis and severe eczema. Similar patterns for both ages were observed for regional analyses, and were consistent with gender and affluence categories and with current symptoms of all three conditions.

 Conclusions

If the association between fast foods and the symptom prevalence of asthma, rhinoconjunctivitis and eczema is causal, then the findings have major public health significance owing to the rising consumption of fast foods globally.

NICE guideline: management of venous thromboembolic diseases and role of thrombophilia testing

The National Institute for Health and Clinical Excellence recently published a clinical guideline on the management of venous thromboembolic disease and thrombophilia testing. Several stand-out recommendations are made which may be practice changing for many physicians, such as catheter-directed thrombolysis for ilio-femoral deep venous thrombosis, routine cancer screening and extended duration of anticoagulation for unprovoked events. In this article, we summarise the key points of the guideline and discuss remaining areas of controversy.

Azithromycin and severe asthma

Brusselle et al1 performed an interesting academic-based randomised controlled trial Azithromycin for Prevention of Exacerbations in Severe Asthma (AZISAST) of azithromycin 250 mgm taken thrice weekly versus placebo as add-on therapy for 26 weeks in non-smoking patients with severe asthma, defined as Global Initiative for Asthma (GINA) steps 4–5, taking high dose inhaled corticosteroids/long-acting bronchodilators and with at least two severe exacerbations within 6 months of study entry. In the half of subjects with lower blood eosinophil counts (≤200/μl) they detected a significant effect on the primary endpoint (severe exacerbations and/or lower respiratory tract illnesses requiring antibiotics) and also on asthma quality of life (AQL). These results lend additional empirical evidence to support my clinical experience that a significant subgroup of patients with uncontrolled severe asthma will experience important clinical benefits from azithromycin, and that this benefit appears to be ‘all-or-none’.2 My most recent primary care-based trial confirmed...

Use of nebulised magnesium sulphate as an adjuvant in the treatment of acute exacerbations of COPD in adults: a randomised double-blind placebo-controlled trial

Background

Intravenous magnesium has been shown to cause bronchodilation in acute severe asthma and in small trials in acute exacerbations of chronic obstructive pulmonary disease (AECOPD). There is also some evidence of benefit from nebulised magnesium in acute severe asthma. Our hypothesis was that adjuvant magnesium treatment administered via repeated nebulisation was effective in the management of AECOPD.

 Methods

In this randomised double-blind placebo-controlled trial, we approached 161 patients with AECOPD presenting to the emergency departments at two New Zealand hospitals with a forced expiratory volume in 1 s (FEV1) <50% predicted 20 min after initial administration of salbutamol 2.5 mg and ipratropium 500 µg via nebulisation. Patients received 2.5 mg salbutamol mixed with either 2.5 ml isotonic magnesium sulphate (151 mg per dose) or 2.5 ml isotonic saline (placebo) on three occasions at 30 min intervals via nebuliser. The primary outcome measure was FEV1 at 90 min.

 Results

116 patients were randomised, 52 of whom were randomly allocated to the magnesium adjuvant group. At 90 min the mean (SD) FEV1 in the magnesium group (N=47) was 0.78 (0.33) l compared with 0.81 (0.30) l in the saline group (N=61) (difference –0.026 l (95% CI –0.15 to 0.095, p=0.67). No patients required non-invasive ventilation. There were 43/48 admissions to hospital in the magnesium group and 56/61 in the saline group (RR 0.98, 95% CI 0.86 to 1.10, p=0.69).

 Conclusions

Nebulised magnesium as an adjuvant to salbutamol treatment in the setting of AECOPD has no effect on FEV1.

Australian New Zealand Clinical Trials Registry ACTRN12608000167369.

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