2 Minute Medicine ® - Respirology

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...

1. This randomized controlled trial showed no evidence that ibuprofen treatment for bronchopulmonary dysplasia reduced premature infant mortality. 2. This study is consistent with other studies examining the role of ibuprofen as a treatment method for patent ductus arteriosus (PDA), showing no effect on mortality rates. Evidence Rating Level: 1 (Excellent) Study Rundown: Neonatal medicine has advanced substantially in recent decades. Yet, the incidence of bronchopulmonary dysplasia has increased in preterm infants with associated mortality...

1. In a retrospective cohort analysis, patients with severe SARS-CoV-2 infection were more likely to experience additional symptoms (e.g., fatigue, shortness of breath) in the 31-150 days following a positive test.  2. It was also found that more severe SARS-CoV-2 infections were linked to increased incidence of diabetes, hematologic disorders, and respiratory diseases in the months following a positive test.  Evidence Rating Level: 2 (Good) The SARS-CoV-2 pandemic has caused millions of infections and deaths worldwide since the first recorded cases...

1. In this randomized controlled trial, patients experiencing symptomatic coronavirus disease 2019 (COVID-19) saw significant improvement in symptom resolution times compared to the placebo group. 2. Further investigation is needed to specifically delineate the impact of simnotrelvir on older COVID-19 patients.  Evidence Rating Level: 1 (Excellent) Study Rundown: COVID-19 has been a major public health concern since the initial pandemic occurrence in 2020. Though vaccinations are beneficial, they have not been completely effective at preventing the more recent strains of COVID-19...

1. Patients in the pembrolizumab plus chemotherapy group reported a significantly greater overall survival compared to those in the chemotherapy alone group (17.3 months vs. 16.1 months). 2. Grade 5 adverse events were comparable in both groups. Evidence Rating Level: 1 (Excellent) Study Rundown: Pleural mesothelioma often presents at an advanced stage, and platinum–pemetrexed chemotherapy is a standard treatment. Pembrolizumab, a programmed cell death protein-1 (PD-1) inhibitor, has been used to treat non-small-cell lung cancer; however, little is known about its use in patients with mesothelioma...

1. In a Malaysian cohort of adults affected with COVID-19, 3.4% were found to develop post COVID-19 condition. 2. Female sex, hospital admission at initial infection, and co-existing comorbidities were identified as risk factors for the development of post COVID-19 condition.  Evidence Level Rating: 1 (Excellent) Post COVID-19 condition has lasting effects on multiple organ systems and can impact anyone who has experienced SARS-CoV-2. There are a multitude of physical symptoms people have experienced, including fatigue and dyspnea, along with psychological impacts...

1. In this randomized-controlled trial, an mRNA-based vaccine was efficacious at preventing symptomatic infection with respiratory syncytial virus (RSV) involving one respiratory sign or symptom in 68.4% of participants. 2. The mRNA-based vaccine was associated with a higher rate of mild to moderate adverse events than placebo. Evidence Rating Level: 1 (Excellent) Study Rundown: RSV is associated with a high incidence of morbidity and mortality globally, particularly for older adults for the phenomenon of immunosenescence and a higher baseline rate of concomitant medical comorbidities...

1. In this randomized controlled trial, rates of ventilator-associated pneumonia (VAP) were lower in ventilated patients using amikacin as compared to a placebo.  2. This difference was maintained over a 28-day follow-up period in the amikacin group. Evidence Rating Level: 1 (Excellent) Study Rundown: VAP emerges 48 hours or more post-mechanical ventilation via an endotracheal tube or tracheostomy, contributing to escalated antimicrobial usage, resistance, prolonged intensive care unit (ICU) stays, and heightened mortality...

1. In this randomized controlled trial, ventilator-associated pneumonia (VAP) was prevented by employing inhaled amikacin in mechanically ventilated patients exceeding three-day duration. 2. Inhaled amikacin was associated with a reduction in VAP incidence during a 28-day follow-up period. Evidence Rating Level: 1 (Excellent) Study Rundown: VAP typically occurs 48 hours or more post-mechanical ventilation via an endotracheal tube or tracheostomy, contributing to escalated antimicrobial usage, resistance, prolonged intensive care unit (ICU) stays, and heightened mortality...

1. In this superiority, parallel-group, open-label, multicentre, randomised controlled trial (RCT), point-of-care (POC) polymerase chain reaction (PCR) testing resulted in earlier use of targeted and adequate antibiotics, but did not result in less antibiotic use compared to the standard of care only (SCO). Evidence Rating Level: 1 (Excellent) With increasing rates of antimicrobial resistance worldwide, the topic of antibiotic stewardship is one of importance and developing efficient and effective ways to avoid antibiotic misuse and excessive use is pertinent...

1. One-third of patients with a cancer signal were correctly diagnosed to have cancer. 2. Patients in the true-positive group underwent more procedures and surgeries compared to those in the false-positive group. Evidence Rating Level: 2 (Good) Study Rundown: Cancer is a leading cause of death worldwide with nearly two million new cases expected to be diagnosed this year. Early cancer screening, particularly for breast, lung, colorectal, and cervical cancers, may reduce cancer-related mortality. The multicancer early detection (MCED) tests aim to detect tumor-associated DNA methylation patterns in cell-free DNA through an easy-to-obtain blood draw...

1. The second greatest burden of lung cancer worldwide is attributed to squamous cell carcinoma 2. Large cell carcinoma represents less than 10% of new lung cancer cases in 2020 Evidence Rating Level : 2 (Good) Study Rundown: Lung cancer is a leading cause of death with a considerable economic burden and an incidence that varies depending on sex and geography. These variations have been attributed to differences in cigarette smoking patterns and chemical composition, as well as the presence of additional lung carcinogens in the environment...

1. In this randomized controlled trial, inhaled fluticasone furoate did not shorten the time to recovery for non-hospitalized patients with mild-to-moderate coronavirus disease 2019 (COVID-19) compared to a placebo.  2.  Adverse events were not common in the fluticasone furoate or the placebo group. Evidence Rating Level: 1 (Excellent) Study Rundown: As the COVID-19 pandemic continues, ongoing efforts are being made to prevent disease transmission and lower the risk of progression to severe disease. Although vaccinations remain the cornerstone of these efforts and effective antiviral agents are now available, there remain accessibility concerns to these therapies in low- and middle-income countries...

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...