Related Articles

Bronchodilators for the prevention and treatment of chronic lung disease in preterm infants.

Cochrane Database Syst Rev. 2012;6:CD003214

Authors: Ng G, da Silva O, Ohlsson A

Abstract
BACKGROUND: Chronic lung disease (CLD) occurs frequently in preterm infants. Bronchodilators have the potential effect of dilating small airways with muscle hypertrophy. Increase in compliance and tidal volume and decrease in pulmonary resistance have been documented with use of bronchodilators in studies of pulmonary mechanics in infants with CLD. Therefore, it is possible that bronchodilators might have a role in the prevention and treatment of CLD.
OBJECTIVES: To determine the effect of bronchodilators given either prophylactically or as treatment for CLD on mortality and other complications of prematurity in preterm infants at risk for or having CLD.
SEARCH METHODS: For this update of the review, searches of The Cochrane Library, Issue 3, 2012; MEDLINE 1966; EMBASE; CINAHL; personal files and reference lists of identified trials were performed in March 2012. In addition Web of Science and abstracts from the Annual meetings of the Pediatric Academic Societies were searched electronically from 2000 to 2012 on PAS Abstracts2view(TM.) No language restrictions were applied.
SELECTION CRITERIA: Randomised controlled trials involving preterm infants were eligible for inclusion. Initiation of bronchodilator therapy had to occur within two weeks of birth for prevention of CLD. For treatment of CLD, treatment had to be initiated before discharge from the neonatal unit. The intervention had to include the administration of a bronchodilator either by nebulisation, metered dose inhaler (with or without a spacer device), intravenously or orally versus placebo or no intervention. Eligible studies had to include at least one of the predefined clinical outcomes (mortality, CLD, number of days on oxygen, number of days on ventilator, patent ductus arteriosus (PDA), pulmonary interstitial emphysema (PIE), pneumothorax, any grade of intraventricular haemorrhage (IVH), necrotising enterocolitis (NEC), sepsis and adverse effects of bronchodilators. Adverse effects of bronchodilators included hypokalaemia, tachycardia, cardiac arrhythmias, tremor, hypertension and hyperglycaemia).
DATA COLLECTION AND ANALYSIS: We used the standard method described in the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011). Two investigators extracted and assessed all data for each study. We reported risk ratio (RR) and risk difference (RD) with 95% confidence intervals (CI) for dichotomous outcomes and weighted mean difference (WMD) for continuous data.
MAIN RESULTS: In this update we identified four randomised controlled trials investigating the effects of bronchodilators in preterm infants. None of these studies fulfilled our inclusion criterion that clinical outcomes should be reported. One eligible study was previously found dealing with prevention of CLD; this study used salbutamol and enrolled 173 infants. No eligible studies were found dealing with treatment of CLD. Prophylaxis with salbutamol did not show a statistically significant difference in mortality (RR 1.08; 95% CI 0.50 to 2.31; RD 0.01; 95% CI -0.09 to 0.11) or CLD (RR 1.03; 95% CI 0.78 to 1.37; RD 0.02; 95% CI -0.13 to 0.17). No statistically significant differences were seen in other complications associated with CLD or preterm birth. No side effects due to salbutamol were commented on in this study.
AUTHORS' CONCLUSIONS: There are insufficient data to reliably assess the use of salbutamol for the prevention of CLD. Further clinical trials are necessary to assess the role of salbutamol or other bronchodilator agents in prophylaxis or treatment of CLD. Researchers studying the effects of bronchodilators in preterm infants should include relevant clinical outcomes in addition to pulmonary mechanical outcomes.

PMID: 22696334 [PubMed - indexed for MEDLINE]

Related Articles

EMT and interstitial lung disease: a mysterious relationship.

Curr Opin Pulm Med. 2012 Sep;18(5):517-23

Authors: Kage H, Borok Z

Abstract
PURPOSE OF REVIEW: Pathogenesis of interstitial lung diseases (ILD) has largely been investigated in the context of the most frequent ILD, idiopathic pulmonary fibrosis (IPF). We review studies of epithelial-to-mesenchymal transition (EMT) and discuss its potential contribution to collagen-producing (myo)fibroblasts in IPF.
RECENT FINDINGS: Endoplasmic reticulum (ER) stress leading to epithelial apoptosis has been reported as a potential etiologic factor in fibrosis. Recent studies further suggest EMT as a link between ER stress and fibrosis. Combinatorial interactions among Smad3, β-catenin and other transcriptional co-activators at the α-smooth muscle actin (α-SMA) promoter provide direct evidence for crosstalk between transforming growth factor-β (TGFβ) and β-catenin pathways during EMT. Lineage tracing yielded conflicting results, with two recent studies supporting and one opposing a role for EMT in lung fibrosis.
SUMMARY: Advances have been made in elucidating causes and mechanisms of EMT, potentially leading to new treatment options, although contributions of EMT to lung fibrosis in vivo remain controversial. In addition to EMT providing a direct source of (myo)fibroblasts, expression of mesenchymal markers may reflect epithelial injury, in which case inhibition of EMT might be deleterious. EMT-derived cells may also contribute to aberrant epithelial-mesenchymal crosstalk that promotes fibrogenesis.

PMID: 22854509 [PubMed - in process]

Related Articles

Pregnancy-Related Deaths Due to Pulmonary Embolism: Findings from Two State-Based Mortality Reviews.

Matern Child Health J. 2012 Aug 21;

Authors: Heyl PS, Sappenfield WM, Burch D, Hernandez LE, Kavanaugh VM, Hill WC

Abstract
This report presents findings from two state-based pregnancy-related reviews of deaths due to pulmonary embolism to describe prevalence, risk factors, and timing of symptoms and fatal events (N = 46). We examined the utility of state-based maternal mortality review teams as a means to gain more complete data on maternal deaths from which guidelines for prevention and intervention can be developed. The Florida Pregnancy-Associated Mortality Review Team and Virginia Maternal Mortality Review Team collaborated on findings from 9 years of pregnancy-related mortality review conducted in each state. Pregnancy-related deaths due to pulmonary embolism occurring within 42 days of pregnancy between 1999 and 2007 in Florida and Virginia were identified. Retrospective review of records was conducted to obtain data on timing of the fatal event in relation to the pregnancy, risk factors, and the presence and timing of symptoms suggestive of pulmonary embolism. Forty-six cases of pregnancy-related death due to pulmonary embolism were identified. The combined pregnancy-related mortality ratio (PRMR) was 1.6/100,000 live births. The PRMR for patients undergoing cesarean section delivery was 2.8 compared to 0.2 among those with vaginal deliveries (95 % CI = 1.8-4.2 and 0.1-0.5 respectively). Women aged 35 and older had the highest PRMR at 2.6/100,000 live births. BMI over 30 kg/m(2) and presence of chronic conditions were frequently identified risk factors. One in five decedents (21.7 %) reported at least two symptoms suggestive of pulmonary embolism in the days before death. This combined state-based maternal death review confirms age over 35 years, obesity, and the presence of chronic conditions are risk factors for pregnancy-related mortality due to venous thromboembolism in the US. Expanding and standardizing the process of state-based reviews offers the potential for reducing pregnancy-related mortality in the US.

PMID: 22907272 [PubMed - as supplied by publisher]

Related Articles

Pulmonary embolism (PE) is a common disease causing significant morbidity and mortality and results in substantial socioeconomic costs to health care systems worldwide. The correct diagnosis, however, poses many challenges. As a result, ongoing research continues to develop and refine new and existing diagnostic algorithms. In this article, we systematically compare and evaluate the available evidence and cost-effectiveness of diagnostic imaging approaches for patients with suspected PE using data in PubMed and EMBASE up to February 2012. The obtained data were systemically analyzed and presented on the basis of the obtained evidence. A cost-effectiveness analysis of imaging techniques or algorithms has been summarized, if available, in dedicated paragraphs for the major issues on diagnostic imaging of PE that are discussed in this article.