呼吸系統疾病新知

Pulmonary Reviews: New and Noteworthy Information From March 2012

2012;17(3):2-3.

Severe sleep apnea appears to be a risk factor for silent strokes
and small brain lesions, researchers reported February 1 at the American Stroke
Association’s International Stroke Conference in New Orleans. They provided
overnight in-hospital polysomnography to 56 consecutive patients who had
experienced acute cerebral ischemia within five days. Sleep apnea was present
in 91% of patients, while severe sleep apnea was present in more than half of
patients with clinically silent infarcts (CSI) and in more than one-third of
patients with chronic microvascular changes (CMC). In addition, sleep apnea was
an independent predictor of CSI. The less favorable outcomes in patients with a
high apnea-hypopnea index and CSI or CMC “warrants further investigations, perhaps
with early non-invasive ventilatory correction of sleep apnea,” the researchers
said.

A new 14-gene expression assay reliably identified the risk of
post-resection mortality among patients with non–small cell lung cancer
(NSCLC), investigators reported in an article published online ahead of print
January 26 by the Lancet. Through research in a cohort of 361 patients
with non-squamous NSCLC, the investigators developed an assay intended to
stratify patients by risk of five-year mortality. The assay was validated in
two cohorts of patients with non-squamous NSCLC: one comprising 433 patients
with stage I disease treated in California and the other comprising 1,006
patients with stage I to III disease treated in China. In the California
cohort, the rates of five-year overall survival were 71.4%, 58.3%, and 49.2% in
low-, intermediate-, and high-risk patients, respectively. In the Chinese
cohort, the survival rates were 74.1%, 57.4%, and 44.6% in low-, intermediate-,
and high-risk patients, respectively.

The FDA approved Kalydeco (ivacaftor) as the first
disease-targeting treatment for a rare form of cystic fibrosis (CF). Kalydeco
treats the CF transmembrane regulator (CFTR) gene’s G551D
mutation in patients six and older, which causes CF in a minority of patients
with the disease. The drug resulted in significant and sustained lung-function
improvement in two 48-week, placebo-controlled studies involving a total of 213
patients. Kalydeco’s most common adverse effects include upper respiratory
tract infection and headache. It is not effective in CF patients with two
copies of the F508 mutation in the CFTR gene, which is the most common
mutation that results in CF.

Postoperative radiotherapy (PORT) does not appear to improve
survival among elderly lung cancer patients, researchers reported in an article
published online ahead of print February 13 by Cancer. They investigated
the therapy’s effects in 1,307 elderly patients with completely resected, stage
III non–small cell lung cancer with N2 disease, 54% of whom received PORT. The
treatment was not associated with improved survival (hazard ratio, 1.11).
Similar results were seen in analyses that adjusted for time trends or were
limited to patients who did or did not receive chemotherapy and who received
radiotherapy planning of intermediate or high complexity.

A combination of inhaled
corticosteroids and long-acting β-agonists appears to be more
effective than inhaled corticosteroids alone for the treatment of severe
asthma, according to an article published online ahead of print January 25 by
the Journal of Allergy and Clinical Immunology. Researchers studied a
cohort of 1,828 asthma patients ages 12 to 56—46% of whom were treated with
inhaled corticosteroids alone and 54% of whom were treated with combination
therapy. Proportional hazard models were used to assess both treatments’
relationships with severe asthma exacerbations, defined as use of oral
corticosteroids, asthma-related emergency department visit, or asthma-related
hospitalization. Combination therapy showed a protective effect that was as
good or better than that of inhaled corticosteroids alone (hazard ratio, 0.65
vs 0.72, respectively).

Extracorporeal membrane oxygenation (ECMO) in awake,
non-intubated patients shows promise as a bridge to lung transplantation, said
researchers in an article published January 20 online ahead of print by the American
Journal of Respiratory and Critical Care Medicine. They studied 60 patients
with terminal respiratory or cardiopulmonary failure who were candidates for
lung transplantation. Of the patients, 26 received EMCO while awake and 34
received mechanical ventilation as their bridge to transplantation. The
survival rates at six months following transplantation were 80% in the awake
EMCO group versus 50% in the mechanical ventilation group. ECMO patients
required shorter postoperative mechanical ventilation and trended toward
shorter postoperative hospital stays. “EMCO support … should be further
evaluated to determine its role in patients with end-stage lung disease
awaiting lung transplantation,” the researchers concluded.

People who consume soft drinks have an increased risk for asthma
and COPD, according to a report in the February Respirology. The
investigators randomly sampled adults in South Australia and interviewed them
via telephone about their soft drink consumption and physician-diagnosed asthma
and COPD. Among the 16,907 participants, high levels of soft drink consumption
were positively associated with both conditions. Soft drink consumption of more
than half a liter per day was reported by 11.4% of all participants, 13.3% of
participants with asthma, and 15.6% of participants with COPD. In a
multivariate analysis that compared participants who consumed more than half a
liter of soft drink per day with those who did not consume soft drinks, with
adjustment for socio-demographic and lifestyle factors, the odds ratios for
asthma and COPD were 1.26 and 1.79, respectively.

—Jack Baney