American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Oct 2022
Historical Redlining Impacts Contemporary Environmental and Asthma-Related Outcomes in Black Adults.
Rationale: Environmental threats and poorly controlled asthma disproportionately burden Black people. Some have attributed this to socioeconomic or biologic factors; however, racism, specifically historical redlining, a U. S. discriminatory mortgage lending practice in existence between the 1930s and the 1970s, may have actuated and then perpetuated poor asthma-related outcomes. ⋯ Furthermore, elevated exposure to filterable particulate matter <2.5 μm, sulfur dioxide, and volatile organic compound emissions (all P < 0.050) and risk of uncontrolled and/or severe asthma (relative risk [95% confidence interval], 2.30 [1.19, 4.43]; P = 0.009) demonstrated inequitable distributions within grade D neighborhood boundaries, disproportionately burdening Black registry participants. Conclusions: The racist practice of historical/HOLC redlining profoundly contributes to long-term environmental and asthma-related inequities in Black adults. Acknowledging the role racism has in these outcomes should empower more specific and novel interventions targeted at reversing these structural issues.
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Am. J. Respir. Crit. Care Med. · Oct 2022
Randomized Controlled Trial Multicenter StudyThe Effect of a Liberal Approach to Glucose Control in Critically Ill Patients with Type 2 Diabetes: A multicenter, parallel-group, open-label, randomized clinical trial.
Rationale: Blood glucose concentrations affect outcomes in critically ill patients, but the optimal target blood glucose range in those with type 2 diabetes is unknown. Objectives: To evaluate the effects of a "liberal" approach to targeted blood glucose range during ICU admission. Methods: This mutlicenter, parallel-group, open-label randomized clinical trial included 419 adult patients with type 2 diabetes expected to be in the ICU on at least three consecutive days. ⋯ By Day 90, 62 of 210 (29.5%) in the intervention and 52 of 209 (24.9%) in the comparator group had died (absolute difference, 4.6 percentage points [95% CI, -3.9% to 13.2%]; P = 0.29). Conclusions: A liberal approach to blood glucose targets reduced incident hypoglycemia but did not improve patient-centered outcomes. Clinical trial registered with Australian New Zealand Clinical Trials Registry (ACTRN 12616001135404).
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Am. J. Respir. Crit. Care Med. · Oct 2022
Randomized Controlled Trial Multicenter StudyClinical Trial of Losartan for Pulmonary Emphysema: Pulmonary Trials Cooperative LEEP Trial.
Rationale: There are no pharmacologic agents that modify emphysema progression in patients with chronic obstructive pulmonary disease (COPD). Objectives: To evaluate the efficacy of losartan, an angiotensin receptor blocker, to reduce emphysema progression. Methods: The trial was a multicenter, randomized, placebo-controlled trial conducted between May 2017 and January 2021. ⋯ The mean (95% confidence interval) percentage emphysema progression was 1.35% (0.67-2.03) in the losartan group versus 0.66% (0.09-1.23) in the placebo group (P = NS). Conclusions: Losartan did not prevent emphysema progression in people with COPD with mild-moderate emphysema. Clinical trial registered with www.clinicaltrials.gov (NCT02696564).