Greetings and welcome to the third edition of my blog. Just a reminder that this blog is meant to be a review of recent studies and data primarily related to respiratory medicine. The blog is also meant to be interactive. I would greatly appreciate your feedback. Please address any comments, questions, or concerns to me at firstname.lastname@example.org. Remember: Health care delivery is fascinating, demanding, dynamic, and ever-changing. No one has all the answers (or even all the questions), so don’t be afraid to jump into the fray, express your opinion, share your experience. Your contributions will only serve to strengthen the profession. In addition, if you would like a copy of the first two blogs, please contact me.
Okay, there’s been a lot of interesting stuff related to respiratory medicine in the medical news over the past few months, certainly more than I can report here, but we’ll see if we can at least mention a few of the most relevant (in my opinion, anyway).
1) A number of reports of studies have demonstrated the superiority of LABA/LAMA over LABA/ICS (LABA = long acting beta agonist; LAMA = long acting muscarinic antagonist; ICS = inhaled corticosteroid) in the treatment of COPD. The most widely reported is the FLAME study. This study looked at the combination of indacterol and glycopyrronium versus the combination of salmeterol and fluticasone. The outcome was the number of exacerbations in a year.
While this is an interesting and well-done study, I can’t help wondering how much of an effect the results will have on prescribing patterns. I have known many people with COPD who are on a LABA/ICS combo plus a LAMA (usually tiotropium). Also, as I have indicated before, clinicians need to consider the cost and availability of these medications as well as the patient’s ability to use them properly.
Another study, the CRYSTAL study looked at improvements in lung function (specifically FEV1) in patients with moderate COPD. They used the same combination of LABA/LAMA and showed positive results. It is probably worth noting, however, that this study was sponsored Novartis.
Interestingly (and perhaps ironically), at the same time the FLAME study was being reported, two other large studies confirmed (based on the data) that triple COPD therapy was superior to monotherapy. These studies were the TRINITY and the TRILOGY. TRINITY compared a combination of LABA, LAMA, and ICS to LAMA alone. TRILOGY compared triple therapy with the combination of ICS and LABA. In both studies, the triple combination resulted in better outcomes. It is worth noting that the drug combos, methodologies, and outcomes were slightly different between studies. I guess now we need a study that compares the triple therapy with LABA/LAMA combo using the same drugs.
2) A small study reported in Medscape showed that scrubs can become contaminated with bacteria. The study looked at 40 ICU nurses and found the transmission of six types of bacteria. Some transmission was from patient to nurse; some was from nurse to patient.
This sort of falls in line with recent discussions involving the potential contamination of clinicians’ clothing, including lab coats. One report estimates that 722,000 healthcare-associated infections occur in US hospital, resulting in about 75,000 deaths each year. While this is certainly a serious problem, apparently the jury is still out on the role clothing plays in infection transmission. On the other hand (no pun intended), no one questions the value of diligent hand hygiene. Please pass along to me (see contact information above) what you are doing in your facility to promote hygiene (i.e. changes in uniform policies).
3) A review of 20 perspective studies and published in BMC Medicine apparently found that a ‘handful of nuts a day may be enough to reduce the risk for death from heart disease and other ills.’ According to the report, researchers found that people who ate the most nuts reduced their risk of coronary heart disease, cardiovascular disease, and cancer. They also found a reduced risk for respiratory disease, diabetes, and infectious disease.
I admit that I didn’t track down the original study so I can’t say how the review was conducted or, perhaps more importantly, which nuts were used. As I read the results, I couldn’t help wondering if peanut butter counts. Also, what about all those poor people with nut allergies?
It will be interesting to see if more studies are done and what the results might be. Also, I wonder if these results will somehow be tied to the very recently reported news that exposing infants to nuts may possibly reduce the risk of developing nut allergies later in life.