Home NIV Offers Significant Benefits for Some with COPD-CRF
Certain patients with COPD and chronic respiratory failure (CRF) would do better to start noninvasive ventilation at home (NIVH) sooner rather than later. That’s the take-home message from researchers publishing in Respiratory Medicine who looked at data on 499,717 Medicare fee-for-service claims on COPD-CRF patients treated between 2016 and 2020.
Among that group, 6,707, or 1.3%, received NIVH within two months of being diagnosed with COPD-CRF. They then assigned these patients to four different time windows based on when they started NIVH. These windows were: 0-7 days, 8-15 days, 16-30 days, or 31-60 days after diagnosis.
The other 493,010 patients in the study served as controls.
The study divided all patients into COPD-CRF phenotypes: COPD-CRF unspecified, COPD-CRF with hypoxia, and COPD-CRF with hypercapnia.
Patients with hypercapnic COPD-CRF saw a 43% reduction in the risk of death if they started NIVH 0-7 days after diagnosis. However, that risk reduction dropped to 31% for those who started 8-15 days after diagnosis and 16% for those who started 16-30 days after diagnosis.
The risk of hospitalization dropped by 23% for hypercapnic COPD-CRF patients who received NIVH within 0-30 days of diagnosis, and emergency department visits declined as well. However, ED visits did not drop in the 0-7 or 0-15 day groups.
Patients with hypoxic or unspecified COPD-CRF did not see a significant reduction in mortality, hospitalization, or ED risks. In addition, patients with hypoxic COPD-CRF had a significantly increased risk of death when they began NIVH 16-30 days following diagnosis.
Furthermore, the study looked at costs associated with NIVH, finding that Medicare spending in the year following diagnosis was correlated with the timing of NIVH for hypercapnic COPD-CRF. A $5484 and $3412 reduction in Medicare spending were seen for those who began NIVH within 0-7 days and 0-15 days after diagnosis.
The use of NIVH significantly increased Medicare spending for patients with hypoxic COPD-CRF. NIVH initiated 8-15 days after diagnosis resulted in a reduced Medicare spending for those with unspecified COPD-CRF, but increases in spending were observed for the other time windows. Read More
How Early Exposure to Antibiotics Can Set People Up for Allergies and Asthma
A study conducted in mice by investigators from Rutgers, New York University, and the University of Zurich adds evidence to the theory that antibiotics in early childhood may be linked to the development of allergies and asthma. Why? Because antibiotics kill healthy bacteria in the digestive tract, opening the door for unwanted immune responses to develop.
The three-part experiment began when five-day-old mice were given water, azithromycin, or amoxicillin. After they had matured, the mice were exposed to house dust mite allergen, and results showed that the mice who had received one of the antibiotics exhibited elevated immune responses.
From there, the researchers wondered if this link between antibiotics and allergies would only be limited to early antibiotic exposure. To find out, they transferred bacteria-rich fecal samples from the first group of mice to a second adult group with no previous exposure to bacteria or other germs. Mice given samples from the mice who had received the antibiotics were not any more likely to develop allergies than mice who were given samples from the mice who received only water.
The last part of the experiment was designed to see if the offspring of the mice who were given the antibiotics when they were young would be in any way affected. When mice in the next generation were given the antibiotic-altered samples, they did, indeed, have an increased reaction to house dust mites than those whose parents were given the samples unaltered by antibiotics.
“The practical implication is simple: Avoid antibiotic use in young children whenever you can because it may elevate the risk of significant, long-term problems with allergy and/or asthma,” said senior study author Martin Blaser, director of the Center for Advanced Biotechnology and Medicine at Rutgers.
The study was published by Mucosal Immunology. Read More
Infants of Color Shortchanged When It Comes to CF Evaluations
A recent study conducted by investigators from Ann & Robert H. Lurie Children’s Hospital of Chicago suggests infants of color who screen positive for cystic fibrosis may not be getting the timely care they need to most effectively manage the disease.
The researchers explain that newborn screening results for CF are usually sent to primary care offices that refer patients with out-of-range results to a clinic with expertise in diagnostic testing and treatment. Recommendations call for these infants to receive a diagnostic evaluation by 28 days of age.
They found infants who were black/African American, American Indian/Native Alaskan, Asian, and/or Hispanic received their diagnostic evaluations at a median of 31 days instead. That compared to 22 days for white infants.
Infants in these racial and minority groups were also more likely to present with symptoms, placing them at higher risk for severe complications.
“Prompt evaluation is critical for all infants with [an] out-of-range newborn screening test for cystic fibrosis,” said study author Susanna McColley, MD. “Because pre-symptomatic treatment of cystic fibrosis is the overarching goal of newborn screening, we advocate for quality improvement activities that lead to timely diagnosis of all infants.”
The study was published by the Journal of Cystic Fibrosis. Read More
Daycare Linked to Worse Outcomes for Preemies with BPD
Daycare may not be suitable for preterm infants diagnosed with bronchopulmonary dysplasia (BPD), report researchers from Children’s Hospital of Philadelphia and elsewhere who looked at data from nine specialty centers across the U.S. participating in the BPD Collaborative Outpatient Registry.
The study included 341 former preemies with BPD who were three years old and under. Results showed those who attended daycare were three times more likely to visit the emergency department and four times more likely to use systemic steroids.
A greater risk of chronic respiratory symptoms, such as coughing or wheezing, along with increased use of rescue medication, was seen in these children as well. The findings were the same whether children attended in-home or center-based daycares.
When the researchers analyzed the data based on age, they found children between six and 12 months were most greatly affected, but the problems persisted in some up to 36 months of age.
The authors acknowledge that many parents need daycare for their children to support their families. Still, they believe health care professionals should counsel them on the potential negative effects daycare may have on their children, especially before their first birthday.
The study appeared in the Journal of Pediatrics. Read More
Pandemic Put a Damper on Smoking Cessation
The pandemic caused a lot of collateral damage in our society, and now American Cancer Society researchers add another harm to the list: the number of people mounting a serious effort to quit smoking declined at the beginning of COVID-19, and that decline persisted for more than a year.
The cross-sectional study was based on data from 2011 to 2020 on around 800,000 people who had smoked in the last year, along with retail scanner sales data between January 2017 and July 2021 for nicotine replacement therapy (NRT) products in 31 U.S. states.
The investigators found that the annual prevalence of past-year quit attempts among U.S. smokers decreased from 65.2% in 2019 to 63.2% in 2020, the first decrease seen since 2011. The decline began in the first quarter of 2020, and the prevalence of quit attempts remained depressed throughout the year.
Those most likely to forego a quit attempt were from groups experiencing disproportionately negative outcomes from COVID-19, including middle-aged people, those with two or more comorbidities, blacks, and people with lower educational levels.
Results from the scanner sales of NRT products showed these sales declined by 1-13% when compared to expected sales, with the decline beginning shortly after the pandemic began and lasting through the first quarter of 2021.
The study was published by JAMA Network Open. Read More
Airway Differences May Explain COPD Outcomes for Women vs. Men
According to researchers publishing in Radiology who looked at nearly 10,000 people taking part in the COPDGene study, smaller airways may be behind the poorer outcomes seen in women with COPD when compared to men.
Participants in the study were between the ages of 45 and 80 and were being seen in 21 centers across the U.S. Among the group were never smokers, current smokers, and former smokers.
Researchers used seven metrics to quantify airway disease on CT — airway wall thickness, wall area percent, Pi10 for airway wall, lumen diameter, airway volume, total airway count, and airway fractal dimension for airway lumen.
Results showed that among never-smokers, men had thicker airway walls than women. However, after adjusting for height and total lung capacity, women had lower airway lumen dimensions than men.
A greater wall thickness was seen in men classified as current or former smokers. Women in those groups had narrower segmental lumen diameter.
When comparing men with women, a unit change in each airway metric resulted in several deficits, including lower lung function, greater dyspnea, poorer respiratory quality of life, lower six-minute walk distance, and worse survival.
“The differences in airway dimensions even after adjusting for height and lung size, and the greater impact of changes in airway size on clinical outcomes in women, was remarkable in that women appear to have a lower reserve against developing airway disease and COPD,” said lead author Surya P. Bhatt, MD, MPH, from the University of Alabama at Birmingham. Read More
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