Chest
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The World Trade Center (WTC) collapse on September 11, 2001, produced airflow obstruction in a majority of firefighters receiving subspecialty pulmonary evaluation (SPE) within 6.5 years post-September 11, 2001. ⋯ Inflammatory biomarkers can be risk factors for airflow obstruction following dust and smoke exposure. Elevated serum GM-CSF and MDC levels soon after WTC exposure were associated with increased risk of airflow obstruction in subsequent years. Biomarkers of inflammation may help identify pathways producing obstruction after irritant exposure.
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Heart failure (HF) is associated with poor prognosis, and the identification of biomarkers of its severity could help in its treatment. In a pilot study, we observed high levels of acetone in the exhaled breath of patients with HF. The present study was designed to evaluate exhaled acetone as a biomarker of HF diagnosis and HF severity. ⋯ EBA not only is a promising noninvasive diagnostic method of HF with an accuracy equivalent to BNP but also a new biomarker of HF severity.
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Patient-reported outcomes (PROs) include questionnaires or surveys that ask patients for their perceptions about things like symptoms they are experiencing or quality of life. For incurable, morbid, life-shortening conditions like idiopathic pulmonary fibrosis (IPF), PROs are particularly germane: They elucidate for clinicians and researchers what it is like for patients to live with such a disease, and they may detect important treatment effects not captured by other metrics (eg, pulmonary physiology). ⋯ When PROs are used as end points in therapeutic trials, analyzing PRO response data can be challenging, but these challenges can be overcome with a transparent, thoughtful, and sophisticated statistical approach. In this article, we discuss some of the basics of PRO assessment, existing knowledge gaps in IPF-related PRO research, and the potential usefulness of using PROs in IPF trials and conclude by offering specific recommendations for an approach to analyzing repeated-measures PRO data from IPF trials.
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Many patients who die within 30 days of admission to the hospital for pneumonia die after discharge. Recently, 30-day mortality for patients with pneumonia became a publicly reported performance measure, meaning that hospitals are, in part, being measured based on how the patient fares after discharge from the hospital. This study was undertaken to determine which factors predict in-hospital vs postdischarge mortality in patients with pneumonia. ⋯ Of elderly patients dying within 30 days of admission to the hospital, approximately one-half die after discharge from the hospital. Comorbidities, in general, were equally associated with death in the hospital and death after discharge
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Bronchodilators are first-line therapy for COPD. There is some evidence that they may increase the risk of cardiac arrhythmias. ⋯ The new use of bronchodilators, particularly ipratropium and LABAs, may increase the risk of cardiac arrhythmias in patients with COPD. Although these results raise concerns regarding LABAs, they were based on few cases and require confirmation in larger cohorts.