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New research about chronic lung disease presented at CHEST 2008


(Monday, October 27, 10:30 AM EST)

The use of in-home photography may be a more cost-effective alternative to in-home inspections for identifying asthma and allergy triggers. Researchers from Truman Medical Center and the University of Missouri, Kansas City, MO, selected 50 adult subjects with persistent asthma to take photos of a predetermined list of areas in their home using a disposable camera. All subjects completed a questionnaire addressing triggers prior to and after taking in-home photos. All film was reviewed with the subjects at the third visit. Subjects then received education on the identified triggers and cost-effective measures to reduce or eliminate exposure. Three of the 50 subjects were randomly selected to receive an in-home assessment by a trained environmental specialist. Triggers identified by in-home inspection by an environmental specialist were very similar to those identified by the use of a disposable camera. Results suggest in-home photography ($13 cost) may be a cost-effective alternative to professional visual home assessments ($300 to $400 cost).


(Monday, October 27, 2:30 PM EST)

Health-care utilization for children with asthma changes with the seasons, peaking in the fall. Using data from the United Healthcare database, researchers from the University of North Carolina reviewed health-care utilization patterns and asthma medication usage in children aged 2 to 5 years and 6 to 12 years from 2002 to 2004. Results showed that health-care utilization was minimal in the summer; however, September consistently served as a point of inflection for health-care utilization for both age groups. In October and November, peak emergency department visits for the two age groups were approximately 2.4 to 2.8 times higher than in July; outpatient visits were approximately 3.1 to 3.3 times higher; and hospitalizations were approximately 3.7 to 5.6 times higher. Asthma controller and reliever medications claims increased beginning in September and peaked in December. Rates for health-care use and claims for asthma medications also were elevated in February.


(Tuesday, October 28, 10:30 AM EST)

New research shows that the erectile dysfunction drug, tadalafil, may be an effective adjunct therapy for patients with pulmonary arterial hypertension (PAH). Italian researchers randomized 405 patients with PAH, of whom 53 percent were taking concomitant bosentan, to two study arms. The groups received either tadalafil or placebo orally once daily as monotherapy or as add-on therapy to bosentan. Compared with placebo, tadalafil, 40 mg, increased 6-minute walk distance, delayed the time to clinical worsening, and improved six of the eight short form (SF)-36 domains. In addition, tadalafil, 40 mg, increased cardiac output and reduced pulmonary artery pressures and pulmonary vascular resistance compared with baseline. Discontinuation due to adverse events was low (11 percent for tadalafil vs. 16 percent for placebo). Researchers conclude that tadalafil may provide an effective oral, once-daily therapy that can be combined with bosentan therapy for patients with PAH.


(Tuesday, October 28, 10:30 AM EST)

New research shows that in-hospital statin use is associated with lower mortality in patients with severe sepsis (SS). In a retrospective study, researchers from AstraZeneca Pharmaceuticals reviewed hospital patient discharges from 500 US hospitals between 2004 and 2006. The number of patients with SS ranged from 64,000 in 2004 to 89,000 in 2006. The percentage of patients with SS among all hospitalizations increased each year from 1.4 percent in 2004 to 1.7 percent in 2006, while in-hospital mortality among all patients with SS decreased each year (35 percent, 2004; 33 percent, 2005; 31 percent, 2006). In-hospital statin use increased each year (13 percent in 2004 to 18 percent in 2006). Each year, patients with SS in the statin group showed a lower mortality rate compared with those discharged from the hospital without a charge for a statin (2004, 28 percent vs. 35 percent; 2005, 26 percent vs. 35 percent; 2006, 23 percent vs. 33 percent). Although a cause and effect relationship could not be determined, researchers conclude that there is a need for further investigation in this area.


(Tuesday, October 28, 1:00 PM EST)

Lung cancer in younger patients may exhibit distinct clinical features than lung cancer in older patients, including better survival rates at each disease stage. Researchers from Stanford Cancer Center in California compared disease characteristics and survival of lung cancer patients aged 15 to 39 years at diagnosis with patients aged ≥40 years at diagnosis. The age-adjusted incidence rate of lung cancer in patients aged 15 to 39 years was 1.2 per 100,000, whereas the rate in patients aged ≥40 years was 141 per 100,000. A higher proportion of younger patients (57 percent) had distant disease at diagnosis compared with older patients (51 percent). Mean 5-year cause-specific survival was 34 percent in the group of patients aged 15 to 39 years and 16 percent in the group aged ≥40 years. In addition, at each disease stage, mean 1- and 5-year cause-specific survival rates were better in the younger group.


(Tuesday, October 28, 1:00 PM EST)

Swimming may be an effective intervention for children with asthma. Taiwanese researchers followed 30 children with asthma to investigate the effects of a 6-week swimming intervention on pulmonary function testing (PFT), peak expiratory flow monitoring (PEFM), and the severity of asthma (SOA). Twenty boys and 10 girls were randomly assigned to receive regular asthma treatment combined with a 6-week swimming training (experimental group) or regular asthma treatment alone (control group). Compared with the control group, the experimental group showed significant improvements in PEFM and SOA. These results suggest that swimming may be an effective nonpharmacologic intervention for children with asthma.


(Wednesday, October 29, 10:30 AM EST)

Thai chi training may help patients with asthma improve their exercise performance and asthma control. Researchers in Thailand enrolled 17 patients with persistent asthma in a 6-week Thai Chi Qigong training program. After Tai Chi Qigong training, patients showed significant improvements in peak flow variability, asthma control test score, negative inspiratory pressure, 6-minute walk distance, and quality of life. Patients also increased their maximum work rate, maximum oxygen consumption, and exercise endurance time. Researchers conclude that Tai Chi Qigong training could be an effective, nonpharmacologic, adjunctive therapy for patients with persistent asthma to help them achieve better asthma control and quality of life.


(Wednesday, October 29, 10:30 AM EST)

New research shows that more pulmonologists and allergists (specialists) disagree with the black box warning (BBW) given to long-acting β-agonists (LABAs) compared with internists and family physicians (primary care physicians). Researchers from North Shore University Hospital in New York surveyed 429 pulmonologists, 395 allergists, 141 internists, and 132 family physicians regarding their awareness of and attitude toward BBWs. Twice as many primary care physicians (45.6 percent) agreed with the BBW compared with specialists (24.2 percent). Primary care physicians also were more likely to alter their prescribing habits compared with specialists (40 percent vs. 34 percent) however, specialists were more likely to discuss the BBW with their patients than were primary care physicians (87 percent vs. 64 percent).


(Wednesday, October 29, 10:30 AM EST)

People who are overweight or obese may not experience the intended effects of asthma medications. In a retrospective analysis, researchers from GlaxoSmithKline analyzed the effect of increasing body mass index (BMI) on achieving asthma control with fluticasone propionate/salmeterol via Diskus compared with montelukast. Overall, a BMI >25 appeared to blunt a person's response to asthma therapy in general.


(Wednesday, October 29, 1:00 PM EST)

Swedish researchers have identified a strong association between smoking and the development of idiopathic pulmonary fibrosis (IPF) in men. The research team investigated a national sample of 172 patients with severe pulmonary fibrosis, of which 133 were judged as having IPF, as well as 745 randomly sampled control subjects from the general population. All participants answered a postal questionnaire about their smoking habits. Results showed that men who smoked were 3.5 times more likely to develop severe pulmonary fibrosis compared with control subjects.


(Wednesday, October 29, 1:00 PM EST)

Despite increased awareness of pulmonary arterial hypertension (PAH), the disease is being diagnosed later and in women who are reaching middle age, according to research from Baylor College of Medicine in Texas. The researchers looked at data from the current REVEAL registry compared with the original National Institutes of Health registry, the French Registry, and a large, single-center US registry. The REVEAL registry confirms that in the 21st century, the US population of patients with PAH is older (mean age of 48), with a higher female preponderance of PAH (4:1) than reported previously. In addition, despite increased awareness of PAH, the time from symptoms to diagnosis has increased by 10 months.


(Wednesday, October 29, 1:00 PM EST)

The use of herbal remedies may be an effective supportive therapy to control symptoms and improve quality of life in patients with advanced stage lung cancer. Researchers from Jafary Medical Clinics in West Virginia followed 15 patients with end-stage primary lung cancer who failed to improve with a conventional treatment of chemotherapy and radiation therapy. Patients were treated with American ginseng for fatigue, morphine sulfate for control of severe dyspnea and pain, licorice root powder for control of severe coughing spells, and bilevel pressure ventilation for respiratory depression related to IV morphine. Two patients also were taking oldenlandia, a Chinese herb for lung cancer. Results showed that licorice and ginseng were effective therapies for the majority of patients, and morphine, used as nebulizer in two patients, was effective in the control of marked dyspnea and pain. One patient lived 4 months using the supportive therapy, while the remaining patients lived 6 to 12 weeks.


(Wednesday, October 29, 1:00 PM EST)

Patients with chronic obstructive pulmonary disease (COPD) may improve muscle strength and exercise endurance by taking essential amino acid supplements. For 3 months, researchers from Italy treated 20 patients with stage 3 and 4 COPD with 8 g of essential amino acids plus usual pharmacologic treatment. Compared with 20 patients in the matched control group, after 3 months, patients in the study group showed a statistically significant increase of muscle strength and covered distance during a 6-minute walk test, and a decrease of breathless degree. Researchers conclude that essential amino acids supplementation may be a valid adjunct therapy for patients with advanced COPD, especially for those presenting with loss of muscle mass or respiratory muscle weakness.


(Wednesday, October 29, 1:00 PM EST)

Patients with rhinitis-related chronic cough may be able to control their cough using nasal sprays. Researchers at Cough Center, Inc, in California treated 266 patients (ages 7 to 85 years) with seasonal allergic (3 percent), nonallergic (65 percent), or mixed rhinitis (32 percent) with open-label combinations of azelastine nasal spray, steroid nasal sprays, ipratropium nasal spray, or cromolyn nasal spray. The median duration of cough was 7 years and the percentage of smokers was less than 1 percent. Of the patients, 72 percent with rhinitis-associated chronic cough experienced improvement with intranasal therapy. The most effective combination therapies were azelastine nasal spray with ipratropium and cromolyn sprays (73 percent) and azelastine nasal spray and intranasal steroid sprays (76 percent). Researches conclude that chronic cough, due to both allergic and nonallergic causes of postnasal drip, can be adequately controlled with the use of nasal rinses and sprays.


Contact: Jennifer Stawarz
American College of Chest Physicians

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