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All creatures great and small
The expression ‘a dog is a man's best friend’ was reported to have been made by Frederick II, king of Prussia in 1789. More than just being ‘man's best friend’, this large Swedish study (JAMA Pediatr 2015;169:e153219 doi:10.1001/jamapediatrics.2015.3219) demonstrated a reduced asthma risk for children who had early exposure to dogs. Children who grew up with exposure to dogs during their first year had a 15% reduction in the risk of developing asthma by age 6. The study also analysed the relationship between farm animals and asthma development and found that exposure to farm animals was associated with a 52% reduction in asthma in school age children.
Re-examining ACE levels in sarcoidosis
In this population-based study (Lung doi 10.1007/s00408-015-9826-3), the authors showed that high serum ACE levels have poor sensitivity and insufficient specificity for diagnosis of sarcoidosis, reinforcing their limited diagnostic use in clinical practice. However, the value of monitoring serum ACE levels to assess disease course remains unclear.
Sleep apnoea in the elderly
The first reports of obstructive sleep apnoea (OSA) in medical publications date from 1965, and 1981 marked the introduction of CPAP as management for OSA. OSA is widely prevalent in the elderly population. Elderly patients with severe OSA, who had cognitive deficits with functional and structural alterations on MRI brain showed improved executive function and mental flexibility after 3 months’ treatment with CPAP according to this single-centre, randomised, pilot study (Chest 2015;148:1214–23. doi:10.1378/chest.15-0171). Neuroimaging of these patients showed that CPAP treatment increased the connectivity in the right middle frontal gyrus and reduced the percentage of cortical thinning.
Lung transplant in short patients
Lung transplantation is a potential treatment for carefully selected patients with end-stage lung disease. The selection of patients depends on various factors and some surgeons attempt to match small transplant candidates with small lung donors as it is believed this leads to better outcomes. According to this study (Am J Respir Crit Care Med doi:10.1164/rccm.201507-1279OC) adult lung transplant candidates of short stature (5′4″ or shorter (≤163 cm)) were shown to have a lower rate of transplants and higher rates of mortality and morbidity, such as respiratory failure, while awaiting transplant than adults of average height. For every 2 inches (5 cm) shorter in height, the likelihood of transplant reduced by about 8% and deaths increased by 12%.
Venous thromboembolism and sepsis
The author reports that this is the first prospective multicentre study (Chest 2015;148:1224–30. doi:10.1378/chest.15-0287) to identify a high incidence of venous thromboembolism (VTE) in patients with severe sepsis and septic shock. More than one-third of intensive care unit patients with sepsis were stated to have developed VTE despite the use of guideline-recommended thromboprophylaxis, indicating that the possibility of VTE should be kept in mind as well as targeted management of factors associated with VTE in this patient group.
René Laennec (1781–1826) who invented the stethoscope also discovered bronchiectasis in 1819. Data on the true incidence, prevalence and mortality of bronchiectasis are minimal. This population cohort study (Eur Respir J 2015. pii: ERJ-01033-2015. Published Online First doi:10.1183/13993003.01033-2015.) demonstrated that the incidence and prevalence of bronchiectasis in UK has increased yearly between 2004 and 2013, especially in elderly patients, affecting >1% of patients older than 70. A high prevalence of bronchiectasis was also seen in patients with asthma (42%) and COPD (36%). Mortality was noted to be twice as high in patients with bronchiectasis as in the general population.
To drain or not to drain?
Pleural drainage is often performed for diagnostic and therapeutic purposes in patients presenting with a new pleural effusion. This is often carried out before radiological imaging with the aim of maximising diagnostic potential—in particular, for assessing the underlying lung parenchyma. However, clinical practice does vary. In this study (Respirology doi:10.1111/resp.12675), the authors reported no additional information was provided if the effusion was drained before imaging which would have affected the clinical decision-making process for patients presenting with unexplained pleural effusion.
TB vaccine development
BCG remains the only available vaccine against Mycobacterium TB. Despite development of the vaccine in 1921 and its subsequent widespread use, TB remains a global public health concern. A new TB vaccination (MTBVAC), which is the first live-attenuated Mycobacterium TB-based vaccine, has shown promising results in phase 1 safety trials (Lancet Resp http://dx.doi.org/10.1016/S2213-2600(15)00435-X). Similar safety to BCG was demonstrated and comparisons of the immunogenicity of MTBVAC with BCG vaccination are underway.
Coxeter P, Del Mar CB, McGregor L, et al. Interventions to facilitate shared decision making to address antibiotic use for acute respiratory infections in primary care. Cochrane Database Syst Rev 2015;12:CD010907. doi:10.1002/14651858.CD010907.pub2
Antibiotic prescribing in primary care is reduced in the short term by interventions that facilitate shared decision-making, although effects on longer-term rates of prescribing are uncertain. More evidence is needed to determine how any sustained reduction in antibiotic prescribing affects hospital admission, pneumonia and death. A variety of interventions were used in the included studies, and there was insufficient information to determine which aspects provide the greatest benefit and how the interventions can be successfully adopted in diverse clinical settings.
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.
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