Respiratory Care Currents

 Published: November 18, 2021

By: Debbie Bunch

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Massachusetts Mourns the Loss of Beverly Adams

Beverly Adams, RRT, who was better known by her colleagues as Sunny Adams, passed away on Nov. 1. Remembered as a dedicated, kind, and supportive therapist to her co-workers and patients alike, she was driven to become an RT after raising a son with asthma. Prior to her retirement, Adams worked for the Massachusetts Respiratory Hospital in Braintree, where she won a national award for engineering a portable respiratory wheelchair to allow her patients access to the outside. She was so loved by her patients that she was often invited to attend their holiday gatherings. Beverly Adams will be missed by her friends and colleagues in the profession.

CPAP, HFNO, Not Linked to Heightened Infection Risk

Concerns that CPAP and high flow nasal oxygen (HFNO) are aerosol generating procedures that could put health care workers at risk of acquiring COVID-19 and other contagious illnesses may have been overblown, report British researchers who received funding from the National Institute for Health Research and the Medical Research Council to conduct a study involving 30 patients with moderate-to-severe COVID-19 at three U.K. hospitals.

Three air and three surface samples were collected from the immediate vicinity of each patient. While 21 of the patients, or 70%, tested positive for COVID-19 during the study, only four out of 90 air samples, or 4%, were positive for the virus. Positive air samples were not any more likely with CPAP, HFNO, or coughing than they were with supplemental oxygen use. Only one sample from the nasopharynx of an HFNO patient was shown to be biologically viable in cell culture assay.

“Although more research is needed to confirm our findings, this is the first indication that NIV care such as CPAP or HFNO may not justify their current classification of being ‘aerosol-generating’ procedures,” said study author Dr. Christopher Green, from the University of Birmingham. The study appeared in a recent edition of Thorax.

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Triage Tool Safely Gauges COVID-19 Severity

A COVID-19 Triage Tool developed by Penn Medicine correctly categorized nearly all of the patients who used it into a safe severity level in a study conducted among 782 patients who used the automated tool and had also contacted the health system’s formal triage phone line.

About half of the patients were deemed to be asymptomatic and more than 30% were found to be moderately or severely ill. The latter group was directed to call their physician or 911 immediately. Since the developers erred on the side of caution when setting the tool up to gauge severity levels, 70% of patients were placed in a higher severity level than that assessed by the live clinicians. Overall, the tool and the clinicians agreed on 29% of the patients, and only six of the patients were found to be at a higher severity level than that which the tool had assigned them.

“From our standpoint, this was a win, given that 99.3% of patients either were assessed exactly as an experienced clinician assessed them or were referred — out of an abundance of caution — to a clinician who later judged these patients to be lower risk than had been originally been suggested,” said co-lead author Maguire Herriman, an MD/MBA student in the Perelman School of Medicine at the University of Pennsylvania and the Wharton School. “Later research can assess absolute accuracy and precision for this kind of tool. It safely served its purpose for us in this situation.”

The online triage tool consists of a Frequently Asked Questions section, along with an automated chatbot that can ask patients specific questions about their conditions. The system documents the patient’s interaction and sends patients to the providers who can help them.

The study was published by Applied Clinical Informatics.

Higher Burden of Infection Seen in Young Kids with CF

Research published in PLOS One may encourage providers to target specific pathogens in children with cystic fibrosis earlier than they do now.

The investigators, from Ann & Robert H. Lurie Children’s Hospital of Chicago, analyzed lower airway samples from 191 patients between the ages of 0 and 21. Among the group, 63 had CF while the others had conditions ranging from cancer and immune deficiency to pneumonia. Using genetic sequencing instead of culture, they were able to detect a broader range of microorganisms in the lower airways and identify distinct pathogens that are more dominant at different ages in patients with CF.

Compared to the other children in the study, those with CF had a higher burden of infection, more inflammation, and a lower diversity of microorganisms. A clear divergence was seen in the toddler age group, despite the fact that progressive lung disease in CF patients typically arises later in childhood.

“Such a clear split from disease controls in this young age group has not been shown before,” said lead study author Jack O’Connor. “Our findings deepen our understanding of the disease trajectory in cystic fibrosis and could help improve outcomes through earlier intervention.”

Does Zinc Really Help?

Many people believe taking zinc supplements can ward off a cold or other respiratory tract infection. A study in BMJ Open suggests they may be right.

The investigators conducted a pooled analysis of 28 clinical trials involving 5,446 adults that looked at outcomes for people who took zinc vs. those who took a placebo. Results showed zinc lozenges or nasal spray prevented five respiratory tract infections per 100 people over a one month period.

Three of the studies looked at the association between zinc and severe symptoms, finding zinc curbed the risk. Overall, symptoms resolved two days sooner for people taking zinc than those taking a placebo, and people who were on zinc were nearly twice as likely to recover during the first week of the illness than those who weren’t.

No serious side effects were seen in those who took zinc, but minor side effects like nausea and mouth or nose irritation were 40% more common in people on the active treatment.

The study did not include patients with COVID-19.

Teens with Asthma Need Help Transitioning to Adult Care

Teens with asthma aren’t being properly prepared to continue their asthma care when they go off to college or out into the world as young adults, conclude researchers who presented the findings of two surveys at the recent American College of Allergy, Asthma and Immunology Annual Scientific Meeting.

The surveys went out to 46 young adults with asthma who were between the ages of 18 and 30, 19 recruited from a pediatric hospital and the other 27 from a university. The participants from the pediatric hospital had received asthma care from an asthma specialist. Most of those from the university were cared for by general providers.

About half of the participants did not recall receiving any transition care from their pediatric asthma provider and only 17% said they’d been given information about an adult provider who could continue with their asthma care.

“Teens who are about to go off to college are at an ideal stage to discuss transition issues,” said study author William Anderson, MD. “They are entering a new era, possibly in a different part of the country, and may be making their own health care decisions for the first time. Introducing concepts about self-care in terms of what will be changing in their lives and what they need to take responsibility for can help them control their asthma symptoms as they begin their journey into adulthood.”

Email newsroom@aarc.org with questions or comments, we’d love to hear from you.

Debbie Bunch

Debbie Bunch is an AARC contributor who writes feature articles, news stories, and other content for Newsroom, the AARC website, and associated emailed newsletters. In her spare time, she enjoys reading, traveling, photography, and spending time with her children and grandchildren. Connect with Debbie by email or on AARConnect or LinkedIn.

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