2 Minute Medicine ® - Respirology

1. 4-year event-free survival was significantly greater in I-SABR (77%) versus SABR alone (53%). 2. More patients in the I-SABR group experienced grade 3 immunological adverse events. Evidence Rating Level: 1 (Excellent) Study Rundown : Standard treatment for early-stage inoperable non-small-cell lung cancer (NSCLC) includes stereotactic ablative radiotherapy (SABR). However, relapses remain common. Although immunotherapy may has shown efficacy in stage III NSCLC, its efficacy in earlier stages remains unknown...

1. In this cohort study, using generic versus brand-name fluticasone-salmeterol was associated with similar outcomes in chronic obstructive pulmonary disease (COPD) patients. 2. Using generic versus brand-name fluticasone-salmeterol was associated with no significant difference in the incidence of COPD exacerbations or pneumonia hospitalizations. Evidence Rating Level: 1 (Excellent) Study Rundown: Chronic obstructive pulmonary disease is associated with substantial morbidity and mortality. However, there can be significant costs associated with the high need for inhalers in these patients...

1. In postoperative patients randomized to receive either 30% FiO 2 and 60% FiO 2 via mechanical ventilation while under general anesthesia, there was no difference in the incidence of postoperive alectasis between the two groups.  Evidence Rating Level: 1 (Excellent) A sizeable proportion of patients undergoing surgery with mechanical ventilation under general anesthesia develop postoperative atelectasis, which itself lends to longer hospital stays and increased 90-day mortality. The literature investigating which amount of inspired oxygen fraction (FiO 2 ) is optimal for patients under general anesthesia has been conflicting...

1. Median overall survival in the atezolizumab group was 10.3 months versus 9.2 months in the chemotherapy group. 2. Patients assigned to atezolizumab had fewer treatment-related adverse events and treatment-related deaths. Evidence Rating Level: 1 (Excellent) Study Rundown: Prior first-line trials in advanced non-small-cell lung cancer (NSCLC) lacked representation for older or patients with reduced fitness. Data surrounding treatment safety and efficacy for advanced NSCLC remains scarce. This randomized controlled trial aimed to compare the safety and efficacy of atezolizumab monotherapy with single-agent chemotherapy for patients with NSCLC who were ineligible for platinum-based chemotherapy...

1. In this randomized controlled trial, dupilumab use was associated with significantly fewer chronic obstructive pulmonary disease (COPD) exacerbations among patients with type two inflammation as compared to a placebo.  2. The incidence of adverse events leading to treatment discontinuation or death and serious adverse events was not significantly different between groups. Evidence Rating Level: 1 (Excellent) Study Rundown: COPD is a lung disease which results in reduced pulmonary function. Patients with COPD exacerbations present with acute worsening of dyspnea and increased sputum volume and purulence...

1. In this prospective cohort study, those who met aerobic and strength training recommendations had a significantly lower risk of influenza and pneumonia mortality than those who met neither guideline. 2. As for muscle strengthening, compared to those who engaged in <2 episodes per week, those who engaged in 2 episodes of strength training had a lower risk of influenza and pneumonia mortality, while those with ≥7 episodes/week had a higher risk. Evidence Rating Level: 2 (Good) The importance of physical activity may extend beyond cardiovascular, neurological, and cancer risk modification...

1. In preterm infants with respiratory distress, there was no difference in time to full enteral feeding (FEF), between the nasal continuous positive airway pressure (NCPAP) and heated humidified high-flow nasal cannula (HHHFNC) groups. 2. The NCPAP group had a lower rate of ineffectiveness than the HHHFNC in treating respiratory distress syndrome (RDS) Evidence Rating Level : 1 (Evidence) RDS is common in preterm infants, and noninvasive respiratory support (NRS) modalities like NCPAP and HHHFNC are employed to mitigate adverse events in these infants...

Patterns and Characteristics of Nicotine Dependence Among Adults with Cigarette Use in the US, 2006-2019 : https://read.qxmd.com/read/37351884 1. Among adults in the US who reported past-month cigarette use, the prevalence of nicotine dependence decreased significantly from 2006-2019 2. Adults over the age of 50 reported the highest degree of nicotine dependence among all age groups.  3. The prevalence of nicotine dependence was greater among those who were male, White race, low income, low educational attainment, divorced or separated, reported substance use or major depressive disorder, or living in a non-metropolitan statistical area...

1. Varenicline, in addition to counseling, increased e-cigarette cessation at 12 and 24 weeks compared to counseling alone.  Evidence Rating Level: 2 (Good) There are currently no evidence-based recommendations to guide e-cigarette (EC) cessation. Given that EC use is increasing worldwide, the number of patients turning to clinicians for guidance on cessation is likely to increase. Researchers aimed to evaluate the effectiveness of varenicline for EC cessation. 140 participants interested in EC cessation were randomized into two groups...

1. In a Swedish cohort, lower cardiorespiratory fitness (CRF) as measured by maximal oxygen consumption (Vo2max) was found to be associated with a greater incidence of colon, lung, and prostate cancer in a 9.6 year period. 2. In patients diagnosed with cancer, greater CRF was additionally found to be associated with lower mortality risk, though the strength of this correlation was affected by factors such as underlying cancer diagnosis and demographic factors. Evidence Rating: 2 (Good)  Although cardiorespiratory fitness (CRF) levels is a recognized and important risk factor for cancer incidence and death, the true quantitative effects are often poorly generalized...

Multiple Pharmacotherapy Adaptations for Smoking Cessation Based on Treatment Response in Black Adults Who Smoke: A Randomized Clinical Trial  : https://read.qxmd.com/read/37338906 1. For Black adults treated for smoking cessation, there were no differences in 7-day abstinence rates at 12, 18, and 26 weeks follow-up, when randomized to a single pharmacotherapy nicotine patch (NP) regimen, compared to a regimen with early opportunities for pharmacotherapy adaptations. Evidence Rating Level: 1 (Excellent) Current guidelines for smoking cessation recommend 8-12 weeks of the same pharmacotherapy even if a patient continues to smoke...

  1 . Increased time in bed through advancing bedtime in adolescents was associated with increased sleep duration. 2. Total sleep time increased by 41.5 minutes for every additional hour spent in bed. Evidence Rating Level: 2 (Good) Study Rundown: Decreases in sleep duration throughout adolescence are linked to negative academic and mental health outcomes. This prospective cohort study sought to identify the impact of an intervention consisting of advancing adolescent bedtimes to increase time in bed (TIB), on total sleep time and quality of sleep...

1. Among patients with severe community-acquired pneumonia (CAP) admitted to the intensive care unit (ICU), hydrocortisone reduced the risk of death compared to placebo. 2. The frequency of adverse events was similar between the hydrocortisone and placebo groups. Evidence Rating Level: 1 (Excellent) Study Rundown: CAP is a prevalent lower respiratory infection affecting millions of individuals worldwide on an annual basis. The death rates of hospitalized and ICU patients with CAP remain significant despite advancements in care...

1. In this cross-sectional study, hypertension, smoking, and arthritis were identified as risk factors for depression in asthmatic individuals. 2. Higher education and increased age were associated with decreased depression risk.  Evidence Rating Level : 2 (Good) Asthma, a chronic inflammatory disorder of the airways, affects over 300 million individuals worldwide. It accounts for 1 in every 250 deaths in the world and imposes a substantial economic and social burden. Asthmatic individuals often experience comorbidities, with depression being particularly prevalent and linked to decreased asthma control and quality of life...

1. Patients with pre-diabetes who were hospitalized with COVID-19 had a greater risk of developing type-2 diabetes mellitus, compared to hospitalized pre-diabetic patients without COVID-19.  Evidence Rating Level: 2 (Good) Recent observations and case reports have suggested an increased risk of developing new-onset type-2 diabetes (T2D) following COVID-19 infection. Researchers aimed to determine the incidence of new-onset diabetes following COVID-19 infection for participants with preexisting prediabetes...

1. Studies that encouraged handwashing reduced acute respiratory infections, including the upper and lower respiratory airways. 2. There was minimal effect of handwashing on influenza, COVID-19, and all-cause mortality. Evidence Rating Level: 1 (Excellent) Study Rundown: Acute respiratory infections (ARIs) account for a large proportion of fatalities among children living in low-income and middle-income countries (LMICs). Although hand hygiene is well-known to reduce the spread of respiratory pathogens, the extent to which handwashing with soap impacts the chance of developing ARIs is unclear...

1. For critically ill patients hospitalized for COVID-19, P2Y12 inhibitors did not improve organ support-free days or survival to discharge compared to usual care.  Evidence Rating Level: 1 (Excellent) Antiplatelet therapy has been proposed in the management of critically ill COVID-19 patients, as platelets play a prothrombotic and proinflammatory role, in patients who are already at high risk of vasculopathy and thrombotic events. Prior studies suggested that antiplatelet therapy did not decrease the risk of requiring organ support, and had no benefit in noncritically ill COVID-19 patients...

1. More patients in the RSV group reported asthma within 5 years compared to those in the non-RSV group. 2. Absence of a prior RSV infection decreased the 5-year risk of asthma by 26%. Evidence Rating Level: 2 (Good) Study Rundown: Respiratory syncytial virus (RSV) is a common childhood pathogen that may be linked to childhood asthma. To date, a definite association between RSV and asthma has not been developed and it is unclear whether prevention of the former may mitigate the latter. This prospective population-based cohort study aimed to assess the association between RSV infection in infancy and the development of childhood asthma...

1. In this randomized controlled trial, bacille Calmette-Guerin (BCG) vaccination did not result in a lower risk of contracting coronavirus disease 2019 (COVID-19) among healthcare workers as compared to placebo. 2. Vaccination with the BCG vaccine did not change the risk of symptomatic or severe COVID-19 among healthcare workers . Evidence Rating Level: 1 (Excellent) Study Rundown: The BCG vaccine was initially developed in order to prevent tuberculosis infection. Recently, it has been proposed to prevent respiratory illness generally in both children and adults...

1. Patients in the high-dose dexamethasone group reported significantly greater mortality within 28 days of treatment. 2. Occurrence of non-COVID-19 pneumonia and hyperglycemia was more frequent in the high-dose dexamethasone group compared to usual care. Evidence Rating Level: 1 (Excellent) Study Rundown: Low-dose corticosteroids has been shown to have clinical benefit among patients with COVID-19 who are hypoxic but not requiring ventilatory support. However, the optimal dose of corticosteroids in this cohort remains unclear and there is limited evidence on whether higher doses of steroids confer morbidity or mortality benefits...