BOSTON (CBS) – Researchers at Duke Health have developed a blood test that can identify whether a sick patient has a bacterial or viral infection, and as Dr. Mallika Marshall reports, that could help doctors determine the appropriate treatment. Scientists at Duke Health have come up with a blood test that can distinguish whether a respiratory infection is bacterial or viral. Dr. Ephraim Tsalik, Lead Author and Assistant Professor of Medicine at Duke, says, “Bacterial infections are ones that typically are treated with antibiotics whereas viral infections like the common cold are typically treated supportively with bed rest, fluids, Tylenol.” Dr. Tsalik and his team developed what they call gene signatures or patterns that show which genes are turned on and off when a person is fi...

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Extracorporeal membrane oxygenation: a breakthrough for respiratory failure.

J Intern Med. 2015 Dec;278(6):586-98

Authors: Frenckner B

Abstract
Extracorporeal membrane oxygenation (ECMO) is a method for providing long-term treatment of a patient in a modified heart-lung machine. Desaturated blood is drained from the patient, oxygenated and pumped back to a major vein or artery. ECMO supports heart and lung function and may be used in severe heart and/or lung failure when conventional intensive care fails. The Stockholm programme started in 1987 with treatment of neonates. In 1995, the first adult patient was accepted onto the programme. Interhospital transportation during ECMO was started in 1996, which enabled retrieval of extremely unstable patients during ECMO. Today, the programme has an annual volume of about 80 patients. It has been characterized by, amongst other things, minimal patient sedation. By 31 December 2014, over 900 patients had been treated, the vast majority for respiratory failure, and over 650 patients had been transported during ECMO. The median ECMO duration was 5.3, 5.7 and 7.1 days for neonatal, paediatric and adult patients, respectively. The survival to hospital discharge rate for respiratory ECMO was 81%, 70% and 63% in the different age groups, respectively, which is significantly higher than the overall international experience as reported to the Extracorporeal Life Support Organization (ELSO) Registry (74%, 57% and 57%, respectively). The survival rate was significantly higher in the Stockholm programme compared to ELSO for meconium aspiration syndrome, congenital diaphragmatic hernia in neonates and pneumocystis pneumonia in paediatric patients.

PMID: 26769616 [PubMed - in process]

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Outcome of Inhaler Withdrawal in Patients Receiving Triple Therapy for COPD.

Tuberc Respir Dis (Seoul). 2016 Jan;79(1):22-30

Authors: Kim SA, Lee JH, Kim EK, Kim TH, Kim WJ, Lee JH, Yoon HI, Baek S, Lee JS, Oh YM, Lee SD

Abstract
BACKGROUND: The purpose of this study was to document outcomes following withdrawal of a single inhaler (step-down) in chronic obstructive pulmonary disease (COPD) patients on triple therapy (long-acting muscarinic antagonist and a combination of long-acting β2-agonists and inhaled corticosteroid), which a common treatment strategy in clinical practice.
METHODS: Through a retrospective observational study, COPD patients receiving triple therapy over 2 years (triple group; n=109) were compared with those who had undergone triple therapy for at least 1 year and subsequently, over 9 months, initiated inhaler withdrawal (step-down group, n=39). The index time was defined as the time of withdrawal in the stepdown group and as 1 year after the start of triple therapy in the triple group.
RESULTS: Lung function at the index time was superior and the previous exacerbation frequency was lower in the stepdown group than in the triple group. Step-down resulted in aggravating disease symptoms, a reduced overall quality of life, decreasing exercise performance, and accelerated forced expiratory volume in 1 second (FEV1) decline (54.7±15.7 mL/yr vs. 10.7±7.1 mL/yr, p=0.007), but there was no observed increase in the frequency of exacerbations.
CONCLUSION: Withdrawal of a single inhaler during triple therapy in COPD patients should be conducted with caution as it may impair the exercise capacity and quality of life while accelerating FEV1 decline.

PMID: 26770231 [PubMed]

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Eosinophilic airway inflammation: role in asthma and chronic obstructive pulmonary disease.

Ther Adv Chronic Dis. 2016 Jan;7(1):34-51

Authors: George L, Brightling CE

Abstract
The chronic lung diseases, asthma and chronic obstructive pulmonary disease (COPD), are common affecting over 500 million people worldwide and causing substantial morbidity and mortality. Asthma is typically associated with Th2-mediated eosinophilic airway inflammation, in contrast to neutrophilic inflammation observed commonly in COPD. However, there is increasing evidence that the eosinophil might play an important role in 10-40% of patients with COPD. Consistently in both asthma and COPD a sputum eosinophilia is associated with a good response to corticosteroid therapy and tailored strategies aimed to normalize sputum eosinophils reduce exacerbation frequency and severity. Advances in our understanding of the multistep paradigm of eosinophil recruitment to the airway, and the consequence of eosinophilic inflammation, has led to the development of new therapies to target these molecular pathways. In this article we discuss the mechanisms of eosinophilic trafficking, the tools to assess eosinophilic airway inflammation in asthma and COPD during stable disease and exacerbations and review current and novel anti-eosinophilic treatments.

PMID: 26770668 [PubMed]