Respiratory Diseases

Parents of young children know that colds are extremely common, especially from fall until spring. Colds account for a large number of pediatric office visits and telephone calls-particularly during "cold season."

New guidelines for community-acquired pneumonia (CAP) issued jointly by the Infectious Diseases Society of America and the American Thoracic Society emphasize the need for communities to adapt the recommendations to local conditions.

In the vast majority of nonsmokers who are not receiving angiotensin converting-enzyme inhibitors and who have no evidence of active disease on chest radiographs, chronic cough is caused by postnasal drip syndrome (recently renamed upper airway cough syndrome [UACS]), asthma, non-asthmatic eosinophilic bronchitis, or gastroesophageal reflux disease (GERD), alone or in combination.

Given the dramatic advances in antimicrobials since penicillin was introduced, why has the mortality rate associated with community-acquired pneumonia (CAP) remained essentially unchanged?

Take this MedPage Today poll on the accessibility of influenza vaccine.

MINNEAPOLIS -- Influenza vaccination reduces older adults' risk of hospitalization and mortality, researchers affirmed, despite lingering questions.

ROCKVILLE, Md. -- Afluria was approved today by the FDA as the sixth seasonal influenza vaccine on the U.S. market. Manufactured by Australia's CSL Limited, the company will produce about two million doses for this year's flu season.

WASHINGTON -- Influenza vaccination may save many fewer older patients' lives than generally claimed, according to researchers here.

ATLANTA -- Influenza vaccination rates have not rebounded after widespread vaccine shortages in the 2004-2005 flu season, CDC investigators said.

ROCKVILLE, Md. -- The FDA has expanded the indications for FluMist, a nasal influenza vaccine, to include children ages two to five.

abstract: While the risk factors for aspiration pneumonia are similar to those for aspiration pneumonitis, the 2 syndromes have different presentations. Aspiration pneumonia tends to occur in older patients or in those with neurological diseases, and the aspiration is not usually witnessed. Aspiration pneumonitis is more likely to occur in patients undergoing anesthesia or in those with acute drug and alcohol overdoses, and the aspiration is often witnessed. The workup may include bedside assessment of the cough and gag reflexes, chest radiography, videofluoroscopic imaging, or fiberoptic endoscopy. Empiric antibiotic therapy should be avoided in most patients with pneumonitis; however, antibiotics may be indicated for those at high risk for bacterial colonization of oropharyngeal and gastric contents who have fever, increasing sputum production, or new infiltrates or for those who fail to improve within 48 hours. (J Respir Dis. 2007;28(9):370-385)

A 43-year-old woman presented to the emergency department with complaints of severe dyspnea, wheezing, and cough productive of white sputum. She had received a diagnosis of asthma 3 years earlier, based on symptoms of wheezing and cough. Since then, her drug regimen has included intermittent use of albuterol.

Evaluation of a radiograph's quality requires some understanding of the technical factors involved in the production of an x-ray image. Without such understanding, the risk of making an interpretive error is increased.

A 52-year-old woman presented to her primary care physician complaining of a nonproductive cough and dyspnea on exertion. These symptoms had a subacute onset over 4 weeks before her initial visit. She denied fever, sputum production, hemoptysis, chest pain, palpitations, abdominal pain, nausea, vomiting, and diarrhea. She did not have any known sick contacts.

abstract: Common causes of poorly controlled asthma include nonadherence to long-term inhaler therapy; environmental exposures; and uncontrolled comorbidities, such as allergic rhinitis. Adherence can be limited by many factors, including inadequate patient education, medication cost, prior failed treatment, poor physician-patient relationship, unrealistic expectations for therapy, and depression. For patients who have a poor perception of their symptoms, emphasizing the "disconnect" between symptoms and pulmonary function can help motivate them to monitor themselves with a peak flow meter and to adjust their medication accordingly. For patients with allergic triggers, instituting allergen-specific environmental controls can decrease symptoms and urgent care visits for asthma. Chronic rhinosinusitis and gastroesophageal reflux disease can also contribute to difficult-to-control asthma, and treatment of these comorbidities can help reduce asthma symptoms. (J Respir Dis. 2007;28(9):365-369)

TUCSON, Ariz. -- For many adults with poor airway function or COPD, the genesis of the problem may have been in the womb, researchers reported.

ABERDEEN, Scotland -- COPD patients may be as much at risk from air pollution inside their homes as they are outside, researchers found.

COLUMBUS, Ohio -- Spirometry can help emergency departments distinguish between the wheezing of acute asthma in adolescents and vocal cord dysfunction, found investigators here.

ANN ARBOR, Mich.-- Only one in three patients who are told they have chronic obstructive pulmonary disease (COPD) have had that diagnosis confirmed with spirometry.

Tuberculin-type hypersensitivity is characterized by marked spongiotic dermatitis with intraepidermal and subepidermal vesiculation and scattered eosinophils.

MONTREAL -- Chronic obstructive pulmonary disease patients who inhaled corticosteroids had a 70% increase in the risk of pneumonia hospitalization over those not given the drugs, researchers here reported.

abstract: Idiopathic pulmonary fibrosis (IPF) is a chronic interstitial lung disease of unknown etiology that leads to progressive fibrosis and respiratory failure. Patients with IPF typically present in their sixth to seventh decade of life with the insidious onset of progressive dyspnea and cough. Lung histopathology reveals the distinct lesion of usual interstitial pneumonia (UIP), and other causes of UIP, such as collagen-vascular disease, drug exposure, or occupational exposures, must be excluded. A confident clinical diagnosis of IPF can often be made without resorting to surgical lung biopsy if certain clinical features are present and a typical pattern is identified on high-resolution CT (HRCT) scanning of the thorax. Changes on HRCT scans that are typical for UIP include a predilection for peripheral and basilar lung zones with patchy involvement and sparing of more central areas, especially in upper lung zones. (J Respir Dis. 2007;28(7):283-292)

abstract: Tuberculous pericarditis, while relatively rare in the United States, is an important cause of pericardial disease in countries where tuberculosis is prevalent. Patients are most likely to present with chronic disease--effusive and/or constrictive. Those with effusive pericarditis often present with tamponade. Patients with constrictive pericarditis exhibit features of systemic and pulmonary venous congestion. An elevated level of adenosine deaminase in pericardial fluid is a good marker for tuberculosis. The presence of granulomas or case-ation necrosis in pericardial tissue confirms the diagnosis. If treatment of effusive tuberculous pericarditis is delayed, constrictive or effusive-constrictive disease usually develops, resulting in a high mortality risk. In addition to a standard antituberculosis regimen, treatment of tuberculous pericarditis may include adjuvant therapy with corticosteroids, pericardiocentesis, and/or pericardiectomy. (J Respir Dis. 2007;28(7):278-282)

A 53-year-old woman presented to the emergency department complaining of substernal chest pain that awoke her from sleep. The chest pain was associated with left shoulder numbness, radiating to her back, and was partially alleviated with sublingual nitroglycerin. During this episode, the patient had a cough productive of yellow phlegm and one instance of cough productive of 1 tbs of bright red blood.

ROCKVILLE, Md. -- The death of cystic fibrosis patient had led the FDA to alert physicians about the risk of prescribing premixed colistimethate for inhalation with a nebulizer.

TORONTO -- An investigational oil-and-water adjuvant for flu vaccines -- tested in conjunction with a vaccine against avian flu -- is safe, a researcher said here.

TORONTO -- Highly pathogenic avian flu is rarely transmitted to people and apparently never in a mild or asymptomatic form, a Thai researcher said here.

Bronchial thermoplasty is a procedure designed to reduce airway smooth muscle mass and, as a result, reduce bronchoconstriction in persons with asthma. In this procedure, radiofrequency current is applied to the walls of the central airways during a series of bronchoscopies. The results of a randomized controlled study conducted in 11 centers in 4 countries suggest that this intervention is beneficial.

Does adding an inhaled corticosteroid to treatment with a long-acting ß2-agonist help prevent exacerbations of chronic obstructive pulmonary disease (COPD)? According to Kardos and associates, the answer is yes.

LONDON -- A single oral dose of vitamin D may give the immune system enough ammunition to fight off tuberculosis for six weeks after exposure, researchers here found.