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Quality of life aids lung cancer prognosis

Self-reported quality of life at the time of lung cancer diagnosis has a significant impact on patients’ survival, show US study results.

Mediastinal lymph node dissection in early-stage non-small cell lung cancer: totally thoracoscopic vs thoracotomy

OBJECTIVES

Although major pulmonary resections for early-stage non-small cell lung cancer (NSCLC) are more and more frequently performed through thoracoscopy, the adequacy of lymphadenectomy achieved via this approach is still questioned. The aim of this study was to evaluate the results of lymph node dissection (LND) during totally thoracoscopic (TT) major pulmonary resections.

 METHODS

Clinical and pathological data of consecutive patients who underwent lobectomy or segmentectomy for clinical-N0 NSCLC between 1 January 2007 and 31 December 2009 were reviewed. The main evaluation criterion was the number of mediastinal lymph nodes (LNs) and mediastinal stations dissected through a TT approach when compared with the classical posterolateral thoracotomy (PLT) approach.

 RESULTS

A total of 296 major pulmonary resections (278 lobectomies and 18 anatomic segmentectomies) for clinical stages I–II NSCLC were performed, 96 via a TT approach and 200 through PLT. Patients' clinical characteristics were similar in both groups. The overall—i.e mediastinal and lobar—number of dissected mediastinal LNs and of dissected mediastinal stations were similar in both groups (TT: mean ± SD = 17.7 ± 8.2; PLT: 18.2 ± 9.3(P < 0.937) and 3.2 ± 0.9 vs 3.4 ± 0.9, respectively). The overall numbers of stations (TT: mean ± SD 5.1 ± 1.1; PLT: 4.5 ± 1.2) and LNs (TT: 22.6 ± 9.4, PLT: 25.4 ± 10.8) were slightly but significantly different between the two groups (P < 0.001 and P = 0.033, respectively); there was no difference in terms of post-operative complications, although patients from the TT group had significantly fewer days with the chest tube (mean ± SD = 4.0 ± 1.8 vs 5.7 ± 3.9, P < 0.001) and shorter length of stay (7.0 ± 2.5 days vs 10.3 ± 7.4, P < 0.001).

 CONCLUSIONS

For patients undergoing thoracoscopic lobectomy or segmentectomy for clinical early-stage NSCLC, the quality of mediastinal LND is equivalent to that performed by thoracotomy.

Cytokines in Induced Sputum: A Role for the Ratio of IL-6/IL-13 in the Differentiation of Asthma and Chronic Obstructive Pulmonary Disease

Source: Respiration

Association of adult-onset asthma with specific cardiovascular conditions

While asthma is known to be associated with cardiovascular disease (CVD), the relation to specific manifestations of CVD has not been previously described. Our objective was to explore the relation of child and adult-onset asthma with specific CVD conditions.

Methods : We examined data from 16,943 (projected 178 million) U.S. adults aged 18–90 years old with relevant information on asthma and CVD. The study was a cross-sectional analysis of the National Health and Nutrition Examination Survey 1999–2006. We determined the prevalence of CVD risk factors and likelihood of CVD conditions according to gender and asthma status using multiple logistic regression adjusted for age, gender and other CVD risk factors.

Results : The proportions of subjects with child and adult-onset asthma were 4.8% (n =702) and 3.3% (n =534), respectively. Adult-onset asthma was significantly associated with total CVD (OR=2.07, CI=1.2–3.7), but child-onset asthma was not associated with any CVD conditions. Of the four specific CVD endpoints, adult-onset asthma overall was only associated with coronary heart disease (CHD) (OR=2.26, CI=1.2–4.2) in the total population.

Conclusions : Our data suggests that CHD is the major cardiovascular condition associated with asthma; a prospective study must be done to confirm a causal relationship.

Patients’ experience of asthma control and clinical guidelines: Perspectives from a qualitative study

Clinical guidelines consider the concept of ‘asthma control’ as the primary goal of asthma treatment. This study aimed to explore patients’ views of concepts that are important for understanding and evaluating asthma control.

Methods : Patients with mild to severe asthma in four countries completed the Asthma Control Questionnaire (ACQ) and discussed their experiences in focus groups. Clinicians evaluated patients’ levels of asthma control based on Global Initiative for Asthma (GINA) guidelines. Clinician- and questionnaire-based ratings of asthma control were compared. Thematic analysis was used to identify key concepts from focus group transcripts.

Results : The sample consisted of 55 patients. Classification of asthma control, based on the ACQ, was consistent with clinician rating in 28 cases (51%). In focus groups, patients discussed concepts related to symptoms, asthma attacks (exacerbations), activity limitations, panic/fear, tiredness, sleep disturbances (nocturnal awakening and difficulty falling asleep), and rescue medication use when describing asthma control. Clinical guidelines also focus on symptoms, activity limitations, rescue medication use, and exacerbations but, in addition include lung function parameters. Guidelines do not take into account asthma-related panic/fear or tiredness and sleep disturbances beyond nocturnal awakening.

Conclusion : The results of this study suggest that patients’ understanding of asthma control extends beyond the usual clinical manifestation of respiratory symptoms and lung function. This may have implications for clinical practice, for setting and achieving the goals of asthma control as well as for evaluation of treatments for asthma from the patients’ perspective.

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