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American Thoracic Society Journal news tips for February

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www.ProHealth.com • February 14, 2003


NEW TREATMENT FOR INFANT AIRWAY DISEASE

Clinical researchers saw an increase in symptom-free days and nights, a reduction in daytime cough, and a significant delay in exacerbations for 61 infants treated with montelukast for reactive airway disease. This problem commonly follows the highly contagious pediatric illness called respiratory syncytial virus (RSV) bronchiolitis. Danish medical scientists investigated 116 infants who had symptoms of moderate to severe RSV bronchiolitis that required hospital admission.

According to the investigators, the infants on the montelukast, who were, on average, 9 months of age, were free of any symptoms during 22 percent of their days and nights, as compared with 4 percent symptom-free days and nights for the 55 children on placebo. The researchers believe that the treatment affects the reactive airway disease secondary to the bronchiolitis rather than the active inflammatory changes associated with the bronchiolitis. The research appears in the first issue for February 2003 of the American Thoracic Society’s peer-reviewed American Journal of Respiratory and Critical Care Medicine.

RHINITIS ASSOCIATED WITH INCREASED BLOOD PRESSURE IN MEN

Men with a common inflammation of the mucous membrane of the nose called rhinitis had higher systolic blood pressure and more hypertension that those without the upper respiratory disorder. According to the authors of this study, approximately 25 percent of the population living in industrialized countries has both rhinitis and hypertension.

The researchers also noted that elevated systolic pressure, the higher of the two readings, is a strong predictor of adverse cardiovascular events and total mortality than diastolic. The investigators assessed 316 adults, aged 28 to 56 years, as part of the European Health Study. During their examination, participants answered standardized questionnaires that were administered by trained interviewers, and then underwent lung function and blood pressure tests.

The investigators said that the association between rhinitis and systolic blood pressure appeared to be strong. Yet the relationship was not found in women. The study appears in the second issue for February 2003 of the American Thoracic Society’s peer-reviewed American Journal of Respiratory and Critical Care Medicine.

MEDICAL LAB WORKERS HAVE INCREASED RISK OF TUBERCULOSIS

In a large study involving 17 Canadian acute care hospitals that were rated moderate to high risk for hospital-based tuberculosis (TB) transmission, laboratory workers were at increased risk of infection from the disease as demonstrated by a TB skin test conversion. Their risk was similar to that of exposed clinical staff. The reasons cited by the investigators were missed or delayed medical diagnoses, a higher proportion of TB deaths in the hospitals, and lower average air change rates in pathology work areas.

The researchers interviewed and skin tested 411 microbiology and pathology technicians and 338 nonclinical personnel. Of those participants, 111 lab technicians and 74 nonmedical personnel had a prior negative tuberculin skin test for comparison purposes. From this group, 14 lab technicians and 4 nonclinical personnel had test conversions. According to the authors, tuberculin test conversion (a positive test for TB exposure) was significantly associated with work in pathology and indicators of delayed diagnoses of patients with the disease.

Among the 459 patients who were hospitalized with TB during the study period, the correct diagnosis was missed (and the patient not isolated) in 45 percent; treatment was delayed by 1 week or more in 30 percent; and 12 percent died. The study appears in the second issue for February 2003 of the American Thoracic Society’s peer-reviewed American Journal of Respiratory and Critical Care Medicine.

EXERCISE CAPACITY BEST MORTALITY PREDICTOR FOR COPD PATIENTS

Exercise capacity is the best predictor of mortality in chronic obstructive pulmonary disease (COPD) patients. Japanese researchers studied 144 patients with stable COPD. At the five-year follow-up examination, 31 had died with 20 deaths caused by COPD or related causes. Their key finding was that exercise capacity was the most significant criterion related to mortality after investigators considered age, pulmonary function, body mass index (BMI) and health status. With COPD, patients suffer from persistent obstruction of the airways associated with either emphysema or chronic bronchitis.

In the past, physicians have regarded lung function values associated with a test called forced expiratory volume in 1 second (FEV1) as the most important predictor of mortality in COPD, along with age. The researchers said that exercise capacity in COPD patients was affected by important, complex factors including ventilation, gas exchange, circulation, muscular function, nutritional status, and disease symptoms.

Thus, they believe that exercise capacity could evaluate the severity of COPD more comprehensively and objectively than airflow limitation as defined by FEV1. The research was published in the second issue for February 2003 of the American Thoracic Society’s peer-reviewed American Journal of Respiratory and Critical Care Medicine.



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