2 Minute Medicine ® - Respirology

1. Time in hospital was modestly reduced in both intervention groups compared to the control. 2. There was little to no improvement in symptom alleviation with oseltamivir and peramivir compared to control. Evidence Rating Level: 1 (Excellent) Study Rundown: There is little consensus around the first-line antiviral treatment for severe influenza. This systematic review of randomized controlled trials assessed different antivirals used in hospitalized patients with severe influenza. This study aimed to assess the effectiveness of various antiviral drugs, including oseltamivir, peramivir, and zanamivir, in reducing important clinical outcomes compared to placebo or standard care...

1. Using either procalcitonin or c-reactive protein as a biomarker to guide antibiotic treatment in patients with community-acquired pneumonia reduces the length of treatment course with no effect to time to reach stability or new antibiotic prescriptions Evidence Rating Level: 1 (Excellent)  20-50% of the 3.3 million people who develop community-acquired pneumonia (CAP) need to be hospitalized every year. Treatment of CAP is recommended to be a 5-21 day course of antibiotics yet in practice, patients are treated for longer than recommended...

1. Median overall survival was 41 months in the TKI-only group vs 40 months in the TKI-SRS group, with HR 0.96 (non-significant). 2. Time to CNS progression was improved in the TKI-SRS group with HR 0.63 (significant), and this was especially seen in patients with BM ≥1 cm, HR 0.60 (significant). Evidence Rating Level : 2 (Good) Study Rundown: Stereotactic radiosurgery (SRS) is the preferred radiation treatment for limited brain metastases (BM) in EGFR/ALK-mutated non-small cell lung cancer (NSCLC) however newer-generation tyrosine kinase inhibitors (TKIs) have shown promising CNS response rates...

1. Wearing surgical face masks was superior to not wearing surgical face masks in reducing the risk of respiratory symptoms over 14 days among Norwegian adults. Evidence Rating Level: 2 (Good) During the COVID-19 pandemic, wearing face masks was a widely implemented public health measure to limit the spread of the virus; however, its effectiveness in lowering the risk of respiratory infections is mixed. This pragmatic parallel two-arm individually randomized superiority trial thus evaluated the personal protective effect of wearing versus not wearing surgical face masks in public spaces over 14 days on self-reported symptoms consistent with a respiratory infection...

1. Patient data from a Taiwanese national database demonstrated that those who took fluoroquinolones had a greater risk of aortic and mitral regurgitation. 2. When excluding patients treated for pneumonia however, patients who took fluoroquinolones had a greater risk of mitral but not aortic regurgitation. Evidence Rating Level: 2 (Good) Fluoroquinolones (FQs) are broad-spectrum antibiotics used to treat a variety of infections. There is conflicting evidence for whether FQs increase the risk of aortic and mitral regurgitation...

1. In this randomized controlled trial, patients with chronic obstructive pulmonary disease (COPD) and type 2 inflammation who received dupilumab had a lower annualized rate of moderate or severe exacerbations than those who received a placebo. 2. The change in forced expiratory volume in 1 second (FEV1) from baseline to week 12 and week 52 was significantly greater in the dupilumab group. Evidence Rating Level: 1 (Excellent) Study Rundown: COPD is a progressive disease of the lungs characterized by irreversible airflow obstruction and associated with high morbidity and mortality...

1. In this randomized controlled trial studying critically ill adults, pantoprazole use was associated with a lower risk of clinically important upper gastrointestinal bleeding compared to placebo use. 2. There was no significant increase in C. difficile infection, pneumonia infection, or mortality in the pantoprazole group compared to the placebo group.  Evidence Rating Level: 1 (Excellent) Study Rundown: Individuals with a chronic illness are at a higher risk of developing stress-induced gastrointestinal ulcerations, possibly leading to gastrointestinal bleeding...

1. Incentivizing smoking cessation with financial rewards increased the likelihood of cessation through the first 12 weeks but did not increase cessation at 26 weeks. Evidence Rating Level: 1 (Excellent)  Socioeconomically disadvantaged individuals are less likely to quit smoking. Contingency management uses positive reinforcement to promote drug and alcohol abstinence. Financial incentives could be used to promote smoking cessation in low socioeconomic status (SES) adults. This study aimed to compare long-term effects of low-cost financial incentives for smoking cessation relative to the usual care counseling and pharmacotherapy...

1 . In this randomized controlled trial, adults with undiagnosed asthma or chronic obstructive pulmonary disease (COPD) who received pulmonologist-directed treatment had lower healthcare utilization than those who received usual care. 2. Adults with undiagnosed asthma or COPD who received pulmonologist-directed treatment had improved secondary outcomes, including quality of life, symptom burden, and forced expiratory volume in 1 second (FEV1). Evidence Rating Level: 1 (Excellent) Study Rundown: Asthma and COPD are chronic airway diseases characterized by expiratory airflow obstruction and similar respiratory symptoms, including dyspnea, cough, and wheezing...

1. In this retrospective analysis, compared to nonsmokers, vaping (both within the previous month and at all in the past) was associated with increased incidence of respiratory symptoms. 2. The use of nicotine salts and fruit-flavoured vapes were also associated with increased odds of self-reported respiratory symptoms.  Evidence Rating Level: 2 (Good) Within the past ten years, the use of vapes has increased among US, Canadian, and British adolescents, whereas the prevalence of cigarette smoking has decreased or remained relatively unchanged...

  The Latest Two one-year long, double-blind, randomized phase 3 clinical trials funded by Eli Lilly and Company investigated the efficacy of Tirzepatide (10mg or 15mg), commercialized as Zepbound, in the treatment of obstructive sleep apnea (OSA) in patients with moderate to severe OSA. The first study included OSA patients not on a continuous positive airway pressure machine (CPAP). While the second study included OSA patients on a CPAP machine. Both studies demonstrated that tirzepatide showed a median reduction of up to 63% in the apnea-hypopnea index (AHI) – a measure of restricted/obstructed breathing events per hour...

1. In a cohort of patients with varying lung function assessed through values of FVC and FEV 1 , and no previous depression, participants with the lowest lung function had increased depression levels, compared to individuals with better levels of lung function.  Evidence Rating Level: 1 (Excellent)  Depression is a mental health condition that contributes to disability-adjusted life years and may lead to an increased risk of developing negative health outcomes. Identifying a cost-effective strategy to prevent depression is needed, as the current ones are costly and have limited efficacy...

1. RSV-related ALRI incidence was significantly higher among preterm infants than term infants. 2. This pattern for RSV hospitalizations remained true until infants’ second year of life. Evidence Rating Level: 1 (Excellent) Study Rundown: Infants born prematurely face an increased risk for severe respiratory infections, particularly from respiratory syncytial virus (RSV). Until now, few studies have successfully assessed the global burden and risk factors associated with RSV-related acute lower respiratory infections (ALRIs) in preterm infants...

The Latest A recent multicenter phase 1b/2a clinical trial funded by the National Institute of Health and the Humanetics Corporation investigated the utility of BIO 300, an oral synthetic genistein nanosuspension, as a radioprotectant for patients undergoing chemoradiotherapy for non-small cell lung cancer (NSCLC). Researchers found BIO 300 led to a reduction in Transformation Growth Factor β1 (TGF-β1), a proinflammatory/profibrotic cytokine implicated in lung injury.  BIO 300 did not change the pharmacokinetics of the cancer therapy, and a 65% tumor response rate was achieved...

1. In this randomized controlled trial, there was a decreased risk of any and severe respiratory syncytial virus (RSV) lower respiratory disease in the group that received the vaccine compared to the group that received the placebo. 2. T he vaccinated group had a higher risk of preterm birth than the placebo group . Evidence Rating Level: 1 (Excellent) Study Rundown: RSV is a major cause of respiratory tract infections in young children, particularly infants under six months. The virus particularly affects those living in low- and middle-income countries, where interventions are needed...

1. The overall survival had a significant hazard ratio (0.65) when comparing neoadjuvant chemoimmunotherapy to neoadjuvant chemotherapy. 2. Both groups had similar rates of treatment (and surgical) related adverse events. Evidence Rating Level : 1 (Excellent) Study Rundown: Recent studies have shown evidence for neoadjuvant immunotherapy combined with chemotherapy in resectable NSCLC, though conflicting approvals between regions underscore the need for comprehensive meta-analyses to assess efficacy across different patient subgroups and treatment regimens...

1. Adding chemotherapy to immunotherapy did not prolong OS or PFS, with non-significant differences in HR. 2. Grade 3 or higher immune-related adverse events occurred in 24.3% and 17.9% in the ICI-chemotherapy and ICI-alone groups. Evidence Rating Level : 2 (Good) Study Rundown : Immune checkpoint inhibitors (ICIs) have significantly improved outcomes in non-small cell lung cancer (NSCLC), with pembrolizumab showing promise in older adult populations based on pooled analyses and cohort studies. However, the efficacy and safety of combining ICIs with chemotherapy in older NSCLC patients remain uncertain, with previous analyses failing to demonstrate an overall survival benefit in patients aged 75 and older...

1. Duration of organ support or death at 30 days was lower in the conservative oxygenation group compared to the liberal oxygenation group. 2. Prespecified adverse events were also lower in the conservative oxygenation group. Evidence Rating Level: 1 (Excellent) Study Rundown: The optimal systemic oxygenation target for critically ill children remains uncertain, with liberal oxygenation – the standard of care – posing harm. There is no underlying consensus on the optimal oxygenation target for critically ill children...

1. In this serial cross-sectional analysis, discharge rates for acute pulmonary embolism (PE) in emergency departments (EDs) in the United States (US) remained constant between 2012 and 2020. 2. No baseline characteristics in patients with acute PE were associated with an increased likelihood of discharge from the ED. Evidence Rating Level: 2 (Good) Study Rundown: Acute PE occurs when there is a disruption of blood flow in the pulmonary artery or its branches due to a thrombus, which often originates in the deep veins...

1. Median progression-free survival was greater in the SBRT group than in the standard-of-care group. 2. Patients with NSCLC displayed a significant survival benefit with SBRT in comparison to patients with breast cancer. Evidence Rating Level: 1 (Excellent) Study Rundown: Most patients with metastatic breast cancer develop resistance to systemic therapy. Stereotactic body radiotherapy (SBRT) is a relatively novel technique that may limit disease progression, although its evidence in non-small-cell lung cancer and metastatic breast cancer patients has been limited...