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PulmCCM Roundup #4
All the best in pulmonary and critical care from around the web. Browse all the PulmCCM Roundups.
Childhood obesity increases the risk for asthma, and obesity is also strongly associated with asthma in adults. The mechanisms are likely multiple, complex and interdependent (pro-inflammatory mediators, etc.), not simply causative. Losing weight does seem to improve asthma control in children and adults. Read more in Tracy Hampton's review in JAMA. The New England Journal ran a review article on occupational asthma.
Secondhand smoke is a known risk factor for COPD among never-smokers. In a database of never-smoking Swedes, secondhand smoke was strongly associated with the prevalence of COPD: 4% in those with no secondhand smoke exposure, vs. 15% for those exposed at home and at multiple jobs. Authors estimate the highest-category risk of secondhand smoke as equivalent to smoking 14 cigarettes a day. (Chest)
For patients with relapsed non-small cell lung cancer (recurring after completing standard chemotherapy) who have the wild-type (most common) form of the EGFR gene, guidelines suggest using either more chemotherapy, or an EGFR tyrosine kinase inhibitor like gefitinib (Iressa) or erlotinib (Tarceva). That recommendation was based on scant evidence for efficacy of EGFR tyrosine kinase inhibitors in wild-type individuals. A new meta-analysis in JAMA suggests that in fact, EGFR TKIs aren't as efficacious as old-fashioned salvage chemotherapy for patients with advanced, relapsed non-small cell lung cancer (although neither improved survival relative to the other).
Neuro Critical Care
The New England Journal reviewed traumatic intracranial hemorrhage, including subdural hematomas and arterial bleeds. Is invasive intracranial monitoring advised for most patients with traumatic head bleeds?
Some pregnant women just can't quit smoking, increasing the risk for birth defects and developmental problems in their children, including childhood asthma. In a multicenter randomized trial in the U.S., giving pregnant smoking women vitamin C supplements improved lung function and reduced wheezing in their newborn babies. New England Journal editorialists weigh in on the electronic cigarette controversy and argue that that e-cigarettes deserve a place in the smoking cessation toolkit. Tobacco control programs including banning smoking from indoor spaces, TV ad bans, etc., have saved millions of lives, and continue to, according to public health authorities' estimates.
PulmCCM reported the Choosing Wisely top 5 "don'ts" for pulmonary medicine recently. The official published manuscript is now in Chest. Detsky and Krumholz lamented the "depersonalizing and stressful" environment for hospitalized patients and proposed solutions, including scheduled rounding times by consultants, ensuring adequate rest and better food, and generally treating patients as human beings. Meet you at Mr Jones's room at 8:45 am? (JAMA)