Many studies have reported that antibiotic use may be associated with increased risk of childhood asthma. Respiratory tract infections in small children may be difficult to distinguish from early symptoms of asthma, and studies may have been confounded by "protopathic" bias, where antibiotics are used to treat early symptoms of asthma.

These analyses of a cohort including 1,401 US children assess the association between antibiotic use within the first 6 months of life and asthma and allergy at 6 years of age between 2003 and 2007. Antibiotic exposure was associated with increased risk of asthma (adjusted odds ratio = 1.52, 95% confidence interval (CI): 1.07, 2.16). The odds ratio if asthma was first diagnosed after 3 years of age was 1.66 (95% CI: 0.99, 2.79) and, in children with no history of lower respiratory infection in the first year of life, the odds ratio was 1.66 (95% CI: 1.12, 3.46). The adverse effect of antibiotics was particularly strong in children with no family history of asthma (odds ratio = 1.89, 95% CI: 1.00, 3.58) (P(interaction) = 0.03). The odds ratio for a positive allergy blood or skin test was 1.59 (95% CI: 1.10, 2.28).

The results show that early antibiotic use was associated with asthma and allergy at 6 years of age, and that protopathic bias was unlikely to account for the main findings.

The reproducibility of 6-minute walking test (6MWT) needs to be more solidly studied.

This study aimed to investigate the reproducibility of two 6MWT performed in subsequent days in a large and representative sample of patients with chronic obstructive pulmonary disease (COPD) and to quantify the learning effect between the two tests, as well as its determinants.

In a retrospective observational study, 1514 patients with COPD performed two 6MWT in subsequent days. Other measurements included body composition (dual X-ray absorptiometry), dyspnoea (Medical Research Council scale) and comorbidity (Charlson index).

Although the 6MWT was reproducible (ICC=0.93; p<0.0001), patients walked farther in the second test [391m (95%CI 155 to 585m) vs. 418m (185 to 605m); p<0.0001]. On average, the second 6MWT increased by 27m (or 7%), and 82% of patients improved in the second test. Determinants of improvement ≥42m in the second test (upper limit of the clinically important change) were: first 6MWT <350m, Charlson index <2 and BMI <30&emsp14;kg·m(-2) (OR 2.49, 0.76 and 0.60, respectively).

The 6MWT was statistically reproducible in a representative sample of patients with COPD. However, the vast majority of patients improved significantly in the second test by an average learning effect of 27m.

Patients with chronic obstructive pulmonary disease (COPD) are at increased risk for both the development of primary lung cancer, as well as poor outcome following lung cancer diagnosis and treatment. Because of existing impairments in lung function, patients with COPD often do not meet traditional criteria for tolerance of definitive surgical lung cancer therapy.

Emerging information regarding the physiology of lung resection in COPD indicates that post-operative decrements in lung function may be less than anticipated by traditional prediction tools. In COPD patients, more inclusive consideration for surgical resection with curative intent may be appropriate as limited surgical resections or non-surgical therapeutic options provide inferior survival.

Furthermore, optimizing peri-operative COPD medical care according to clinical practice guidelines including smoking cessation can potentially minimize morbidity and improve functional status in this often severely impaired patient population.

This review summarizes recent research on chronic obstructive pulmonary disease (COPD) among older adults.

RECENT FINDINGS: Recent research on COPD and older adults addresses four key areas: diagnosis and screening, comorbidities, end-of-life care, and management. These key findings include the Rotterdam study's identification of the incidence rate of COPD in older adults being 9.2 per 1000 person-years; a new assessment of FEV1 cut-points associated with increased prevalence of respiratory symptoms and risk of death; development and validation of new mortality scales, the ADO (age, dyspnea, and airflow obstruction) index and the PILE score; older adults with COPD average 9 comorbidities, of which depression, cardiovascular diseases such as hypertension, and chronic renal failure are highly prevalent; nonrespiratory treatments such as proton pump inhibitors, angiotensin-converting enzyme inhibitors, and statins show promise in the management of COPD; and strength may be a protective factor for older adults with COPD.

SUMMARY: Findings suggest that more research on older adults and COPD suggest that aging is a determinant of the progression of disease and that management of this population requires different metrics and strategies.