American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Feb 2020
Comparative StudyPulmonary Outcomes Associated with Long-Term Azithromycin Therapy in Cystic Fibrosis.
Rationale: Chronic azithromycin is commonly used in cystic fibrosis based on short controlled clinical trials showing reductions in pulmonary exacerbations and improved FEV1. Long-term effects are unknown. Objectives: Examine pulmonary outcomes among chronic azithromycin users compared with matched controls over years of use and consider combined azithromycin use in cohorts using chronic inhaled tobramycin or aztreonam. ⋯ Among all cohorts, use of intravenous antibiotics was no different between azithromycin users and controls. Users of inhaled tobramycin and azithromycin had FEV1% predicted per-year decline of -0.16 versus nonusers (95% CI, -0.44 to 0.13), whereas users of inhaled aztreonam lysine and azithromycin experienced a mean 0.49% predicted per year slower decline than matched controls (95% CI, -0.11 to 1.10). Conclusions: Results from this study provide additional rationale for chronic azithromycin use in PA-positive patients to reduce lung function decline.
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Am. J. Respir. Crit. Care Med. · Feb 2020
The Potential Effects of Policy-Driven Air Pollution Interventions on Childhood Lung Development.
Rationale: Although elevated air pollution exposure impairs lung-function development in childhood, it remains a challenge to use this information to estimate the potential public health benefits of air pollution interventions in exposed populations. Objectives: Apply G-computation to estimate hypothetical effects of several realistic scenarios for future air pollution reductions on lung growth. Methods: Mixed-effects linear regression was used to estimate FEV1 and FVC from age 11 to 15 years in 2,120 adolescents across 3 cohorts (1993-2001, 1997-2004, and 2007-2011). ⋯ Comparable results were observed for PM2.5 interventions. Conclusions: We estimated that substantial increases in lung function would occur as a result of interventions that reduce NO2 or PM2.5 concentrations. These findings provide a quantification of potential health benefits of air quality improvement.
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Am. J. Respir. Crit. Care Med. · Feb 2020
Alterations in Oral Microbiota in HIV Are Related to Decreased Pulmonary Function.
Rationale: Mechanisms of HIV-associated chronic obstructive pulmonary disease (COPD) are poorly understood. The oral microbiome shapes the lung microbiome, and gut dysbiosis can affect lung diseases; however, relationships of the oral and gut microbiome to COPD in HIV have not been explored. Objectives: To examine alterations in the oral and gut microbiome associated with pulmonary disease in persons with HIV (PWH). ⋯ No associations with HIV status or lung function were seen with the gut microbiome. Conclusions: Alterations of oral microbiota in PWH were related to impaired pulmonary function and to systemic inflammation. These results suggest that the oral microbiome may serve as a biomarker of lung function in HIV and that its disruption may contribute to COPD pathogenesis.
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Am. J. Respir. Crit. Care Med. · Feb 2020
Comparative StudyEffects of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels Among Patients with Septic Shock: A Bayesian Reanalysis of the ANDROMEDA-SHOCK Trial.
Rationale: A recent randomized controlled trial showed that a peripheral perfusion-guided resuscitation strategy was associated with lower mortality and less organ dysfunction when compared with lactate-guided resuscitation strategy in patients with septic shock, but the difference in the primary outcome, 28-day mortality, did not reach the proposed statistical significance threshold (P = 0.06). We tested different analytic methods to aid in the interpretation of these results. Objectives: To reassess the results of the ANDROMEDA-SHOCK trial using both Bayesian and frequentist frameworks. ⋯ The comparable frequentist odds ratios for 28-day and 90-day mortality were 0.61 (95% confidence interval [CI], 0.38-0.92) and 0.70 (95% CI, 0.45-1.08), respectively. The odds that that patients in the peripheral perfusion-targeted resuscitation arm had Sequential Organ Failure Assessment scores in the lower quartile at 72 hours was 1.55 (95% CI, 1.02-2.37). Conclusions: Peripheral perfusion-targeted resuscitation may result in lower mortality and faster resolution of organ dysfunction when compared with a lactate-targeted resuscitation strategy.