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Statins may decrease all cause mortality in pneumonia

This cohort study compared all cause mortality within 6 months after contracting pneumonia in patients who had been taking a statin prior to developing pneumonia against those who had not. Data were sourced from The Health Improvement Network database and validated for pharmacoepidemiological research; propensity scoring was used for comparative analysis of patients in the two subgroups.

A total of 129 288 patients who had received a statin were matched with 600 241 patients who had not. Following exclusions and restrictions, 942 statin users and 3615 non-users were included in the analysis. Of these, 204 statin users and 1264 non-users died within 6 months of the date of diagnosis of pneumonia. The fully adjusted rate ratio for mortality between statin users and non-users was 0.67 (95% CI 0.49 to 0.87). An estimation of the number needed to treat to prevent one death within 6 months of an episode of pneumonia was 15. ...

GOLD COPD classification and prognostic pessimism regarding ICU admission

Incorporation of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification of severity of expiratory airflow limitation in chronic obstructive pulmonary disease (COPD) into the recent National Institute for Health and Clinical Excellence (NICE) guidelines is welcome and sensible.1 Describing a forced expiratory volume in one second (FEV1) of 51% predicted as ‘mild disease’ fails to capture the loss of lung function and irreversible damage done. Recognition and optimal early management of COPD cannot be overemphasised to limit its long-term health consequences.

However, we have concerns that its adoption without adequate explanation in the UK could have unintended negative consequences in this patient group if presenting acutely unwell, when decisions regarding intensive care and use of invasive mechanical ventilation (IMV) are being made.

Widely varying ICU admission criteria and prognostic pessimism among UK critical care physicians regarding COPD have been demonstrated.2 3...

Genome-wide association studies in lung disease

Genome-wide association studies (GWAS) have provided new insights into the molecular mechanisms of lung function and lung diseases. GWAS, and studies that build upon their findings, will continue to provide evidence aimed at advancing understanding of lung disease.

This paper summarises the key features of a GWAS, references some recent findings and discusses how the chest physician can interpret the validity and utility of future GWAS and related studies.

Standards of care for occupational asthma: an update

The British Thoracic Society (BTS) Standards of Care (SoC) Committee produced a standard of care for occupational asthma (OA) in 2008, based on a systematic evidence review performed in 2004 by the British Occupational Health Research Foundation (BOHRF).

Methods : BOHRF updated the evidence base from 2004–2009 in 2010.

Results : This article summarises the changes in evidence and is aimed at physicians, nurses and other healthcare professionals in primary and secondary care, occupational health and public health and at employers, workers and their health, safety and other representatives.

Conclusions : Various recommendations and evidence ratings have changed in the management of asthma that may have an occupational cause.

Time course and pattern of COPD exacerbation onset

Background

The natural history and time course of the onset of exacerbation events of chronic obstructive pulmonary disease (COPD) is incompletely understood.

Methods

A prospective cohort of 212 patients with COPD was monitored using daily symptom diaries for a median of 2.8 years to characterise the time course of COPD exacerbation onset. Decision rules based on weighted self-reported symptoms were used to define opening and closing of exacerbation events. Event time intervals were analysed and logistic regression was used to determine the effects of patient covariates on exacerbation events.

Results

Patients recorded 4439 episodes of worsening respiratory symptoms from baseline; 2444 (55%) events resolved spontaneously and 1995 (45%) resulted in a COPD exacerbation. In 1115 of the 1995 COPD exacerbations (56%) the onset was sudden and the exacerbation threshold was crossed on the same day symptoms began. In contrast, 44% of exacerbations were characterised by gradual onset of symptoms (median duration from symptom onset to exacerbation 4 days). Patients who experienced sudden onset exacerbations had greater mean daily symptom scores (7.86 vs 6.55 points, p<0.001), greater peak symptom scores (10.7 vs 10.2 points, p=0.003), earlier peak symptoms (4.5 vs 8.0 days, p<0.001) and shorter median recovery times back to baseline health status (11 vs 13 days, p<0.001). Multivariable analysis showed that gradual onset exacerbations were statistically associated with a longer duration of exacerbation recovery (OR 1.28, 95% CI 1.06 to 1.54, p=0.010).

 Conclusions

COPD exacerbations exhibit two distinct patterns—sudden and gradual onset. Sudden onset exacerbations are associated with increased respiratory symptoms but shorter exacerbation recovery times.

 

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