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Journal Chest -- March 2008 news briefs


Children with allergic asthma may benefit from an oral therapy designed to increase tolerance to allergens that trigger asthma and, in turn, decrease asthma symptoms and medication use. In a meta-analysis, researchers from the University of Genoa in Italy reviewed the results of nine studies (441 patients, ages 3 to 18 years) involving sublingual immunotherapy (SLIT) for allergic asthma in children. SLIT involves the oral administration of allergen exacts, either through soluble tablets or drops. Researchers found that SLIT reduced both symptom scores and rescue medication use in children with allergic asthma compared with placebo. Furthermore, the majority of adverse effects associated with SLIT were mild and self-resolving. Researchers conclude that SLIT is clinically effective in asthma in children; however, additional research should be conducted to determine the most effective dose and regimen of administration. Although widely used in Europe, SLIT is not approved by the US Food and Drug Administration for use in the United States. This study is published in the March issue of the journal CHEST.


Patients suffering from Alzheimer disease often experience sleep-disordered breathing, but a new study shows that a drug, commonly used to treat the cognitive symptoms of the disease, may also help to curb sleep disturbances in these patients. In a randomized, double-blind design, researchers from Stanford University and Brazils Universidade Federal de Sao Paulo, evaluated the effect of donepezil on obstructive sleep apnea in 23 patients with Alzheimer disease. The patients were allocated to two groups, donepezil-treated (11) and placebo-treated (12), and polysomnography and cognitive evaluations were performed at baseline and 3 months. Following the test period, researchers found that oxygen saturation, apnea-hypopnea index scores, and cognitive scores all improved, and sleep duration increased in patients treated with donepezil, compared with those treated with placebo. This study is published in the March issue of the journal CHEST.


New research shows continuous positive airway pressure (CPAP) therapy provides many benefits for patients suffering from obstructive sleep apnea (OSA) and heart failure, including an improved prognosis. In the study, Japanese researchers determined the effect of CPAP therapy on the prognosis for 88 patients with heart failure and OSA. The patients were categorized into two groups; CPAP-treated (65) and untreated (23). Those in the CPAP-treated group were further classified according to therapy compliance. The frequency of death and hospitalization was analyzed using multivariate analysis, and after the follow-up period, nearly half of the patients had died or were hospitalized. Researchers concluded that the risk for death and hospitalization was greatly increased in the untreated group, as well as in the patients who used, but were less compliant with, the CPAP therapy. This study is published in the March issue of the journal CHEST.


Family members of patients in the intensive care unit (ICU) are often called upon to make end-of-life decisions regarding their loved ones care. In an effort to help improve decision-making and family outcomes, a new study from the University of Washington, Pulmonary and Critical Care Medicine, Seattle, Washington, determined patient and family characteristics and processes of care associated with family satisfaction with end-of-life decision-making. Researchers administered surveys to 356 families of ICU patients dying in 10 Seattle-Tacoma medical centers. There was an overall response rate of 41%, and the surveys included summary scores for family satisfaction with decision-making and a single item score that indicated the level of support felt during decision-making. Findings suggest that, in situations where life support is withdrawn, family members report more satisfaction during the decision-making process when there was complete chart documentation of the family conference and complete chart documentation of the spiritual care needs of family members. This study is published in the March issue of the journal CHEST.


Contact: Jennifer Stawarz
American College of Chest Physicians

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