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Acute renal failure in cystic fibrosis
The outcome of patients with cystic fibrosis has improved considerably over the past years and some of this benefit has been produced by the use of regular intravenous antibiotics, especially aminoglycosides. There has been recently an increase in reports of acute renal failure (ARF) in cystic fibrosis patients and in this month’s Thorax Smyth and colleagues describe a case-control study of ARF in cystic fibrosis. They show that use of intravenous aminoglycoside, particularly gentamicin, is a risk factor for ARF. In the accompanying editorial Goss suggests that the present evidence does not support the call to ban the use of gentamicin in the cystic fibrosis population, but that careful assessment of renal function is now required in these patients who receive intravenous aminoglycosides.
See pages 532
Severity of motor vehicle crashes in OSA
It is now recognised that patients with obstructive sleep apnoea (OSA) have a higher rate of motor vehicle crashes, but little is known about the severity of these accidents at various stages of OSA. Mulgrew and colleagues examine the relationship between OSA and crash severity from study of provincial insurance records. The authors confirmed the increased rate of motor accidents, but show for the first time that patients with OSA are particularly prone to motor vehicle crashes with personal injury, even those patients with mild OSA. Daytime sleepiness did not predict risk of accidents. In the accompanying editorial, Stradling reviews the evidence for the association of motor vehicle accidents and sleep apnoea and concludes that as the accident rate falls with successful treatment, we need greater awareness of the consequence of OSA with rapid diagnosis and immediate treatment if required.
Assessment for home oxygen therapy
In February 2006, a new Home Oxygen Service was started in England and Wales with the provision of all modalities of home oxygen from a single supplier. Following prescription of home oxygen on a special home oxygen order form, a predetermined tariff is allocated according to device and usage. In this issue, we publish a letter from Deeming and colleagues from Southend, UK who reviewed patients on home oxygen and adjusted their prescriptions and thus tariffs depending on the assessment and actual oxygen usage. This resulted in a substantial cost saving and emphasises the need for assessment and follow up of all patients on home oxygen therapy.
See pages 566
Exercise training in ILD
Although there is a large literature available on exercise training in COPD, there is little information on this topic in patients with interstitial lung disease (ILD). In this issue, Holland and colleagues describe the first randomised controlled trial of exercise training in ILD. Results show that exercise training in this patient group is safe with short-term improvements in exercise capacity, health status and dypsnoea. However by 6 months after intervention, these benefits were no longer present, although a formal maintenance exercise programme was not administered to the ILD patients.
See pages 549