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Bronchial Thermoplasty for Severe Asthma.

Authors: Wahidi MM, Kraft M Abstract Bronchial thermoplasty (BT) is a novel treatment of patients with severe asthma who continue to be symptomatic despite maximal medical treatment. It aims to reduce the smooth muscle mass in the airways by delivering controlled thermal energy to the airway walls during a series of three bronchoscopies. Randomized controlled clinical trials of BT in severe asthma have not been able to show a reduction in airway hyperresponsiveness or change in FEV1 but have demonstrated an improvement in quality of life, as well as a reduction in the rate of severe exacerbations, emergency department visits, and days lost from school or work. The short-term adverse events consist primarily of bronchospasm and occasionally more severe events requiring hospitalizati...

An Official American Thoracic Society/Society of Thoracic Radiology Clinical Practice Guideline: Evaluation of Suspected Pulmonary Embolism In Pregnancy.

Discussion: The recommendations presented in this guideline are based upon the currently available evidence; availability of new clinical research data and development and dissemination of new technologies will necessitate a revision and update.

Fosfomycin/Tobramycin for Inhalation in Cystic Fibrosis Patients with Pseudomonas Airway Infection.

CONCLUSIONS: FTI maintained the substantial improvements in FEV1% predicted achieved during the AZLI run-in and was well-tolerated. FTI is a promising antipseudomonal therapy for patients with CF.

Severe Asthma: Lessons Learned from the NHLBI Severe Asthma Research Program.

The National Heart, Lung and Blood Institute (NHLBI) Severe Asthma Research Program (SARP) has characterized over the past 10 years 1644 asthmatic patients, including 583 individuals with severe asthma.

SARP collaboration has led to a rapid recruitment of subjects and efficient sharing of samples among participating sites to conduct independent mechanistic investigations of severe asthma. Enrolled SARP subjects underwent detailed clinical, physiologic, genomic, and radiological evaluations. In ad...

Inequalities in outcomes for non-small cell lung cancer: the influence of clinical characteristics and features of the local lung cancer service

Background

The treatment given to patients with lung cancer and survival vary between and within countries. The National Lung Cancer Audit (NLCA) linked to Hospital Episode Statistics was used to quantify the extent to which these outcomes are influenced by patient features and/or hospital facilities and performance indicators.

 Methods

All patients with a histological diagnosis of non-small cell lung cancer (NSCLC) were included. Logistic regression was used to quantify the independent influence of features of both patients and hospitals on the likelihood of having surgery and Cox regression was used for survival analyses.

 Results

There were 34 513 patients with NSCLC in our dataset. After adjusting for age, sex, performance status, stage and Charlson Index of comorbidity, patients with NSCLC first seen in thoracic surgical centres (27% of the cohort) were 51% more likely to have surgery than those seen in non-surgical centres (adjusted OR 1.51, 95% CI 1.16 to 1.97). Resection rates varied from 13% to 17% between non-surgical and thoracic surgical centres. Surgery was the most powerful determinant of overall survival (adjusted HR 0.41, 95% CI 0.39 to 0.44).

 Conclusion

A minority of patients with NSCLC first seen in a thoracic surgical centre are more likely to have surgery and to benefit from the survival advantage this confers. This finding suggests that there is an opportunity to improve the outcome for patients with lung cancer in England by optimising access to thoracic surgeons in non-surgical centres.

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