Treating IPF according to ATS/ERS/JRS/ALAT Clinical Practice Guideline 2015 (CME Online)

Understand the ATS/ERS/JRS/ALAT Clinical Practice Guideline for IPF with our online module exploring clinical decision making and the rationale behind the changes.

Free access:

http://www.ers-education.org/cmeonline/selection/treating-ipf-according-to-atsersjrsalat-clinical-practice-guideline-2015/video-introduction.aspx

How to Recycle One of the Most Common Kinds of Litter in the World

Cigarette butts are one of the most common kinds of litter, found everywhere from land to waterways. The tobacco and paper in them will break down, so those can be composted. But the filters contain a plastic, and that can take years to decompose. Yet if the butts are carefully processed, the cellulose acetate can be used to make things such as park benches and pallets. Recycling companies like TerraCycle are also refining their processing methods to create higher-end plastic products.

2016 CHEST issues new antithrombotic guideline update for treatment of VTE disease

Glenview, Ill.— Each year, there are approximately 10 million cases of venous thromboembolism (VTE) worldwide. VTE, the formation of blood clots in the vein, is a dangerous and potentially deadly medical condition and is a leading cause of death and disability worldwide. In this latest evidence-based guideline, Antithrombotic Therapy for VTE Disease: CHEST Guideline, from the American College of Chest Physicians, experts provide 53 updated recommendations for appropriate treatment of patients with VTE.  

http://journal.publications.chestnet.org/article.aspx?articleid=2479255

“This guideline article, another from CHEST living guidelines, provides the most up-to-date treatment options for patients with VTE. The guideline presents stronger recommendations and weaker suggestions for treatment based on the best available evidence, and identifies gaps in our knowledge and areas for future research,” said lead author Clive Kearon, MD, McMaster University.

Key changes to recommendations in the 9th edition to the 10th edition include: 

• Non-vitamin K antagonist oral anticoagulants (NOACs) are suggested over warfarin for initial and long-term treatment of VTE in patients without cancer.  Since publication of the 9th edition, new studies show that NOACs are as effective as VKA therapy with reduced risk of bleeding and increased convenience for patients and health-care providers.
• Routine use of compression stockings is out to prevent postthrombotic syndrome in acute DVT. Based on recent evidence, the 10th edition suggests not to routinely use compression stockings to prevent postthrombotic syndrome in patients with acute DVT. Postthrombotic syndrome is a chronic condition of the leg with swelling, pain, skin discoloration, and even ulcers.  In the 9th edition, compression stockings were routinely suggested as a preventive measure in these patients.
• New isolated subsegmental pulmonary embolism treatment recommendations. The 10th edition suggests which patients diagnosed with isolated subsegmental pulmonary embolism (SSPE) should, and should not, receive anticoagulant therapy.

Fulltext:
http://journal.publications.chestnet.org/article.aspx?articleid=2479255

New rules on driver licensing for patients with obstructive sleep apnea: European Union Directive 2014/85/EU

The widespread recognition that obstructive sleep apnea (OSA) represents an important risk factor for motor vehicle accidents, which is reversed by successful therapy with continuous positive airway pressure (CPAP), has led to a revision of Annex III of the European Union (EU) Directive on Driving Licences. This directive was the result of recommendations from a Working Group established by the Transport and Mobility Directorate of the European Commission in 2012 (McNicholas, 2013). 

The new Directive, which is subject to mandatory implementation by all Member States from 31 December 2015, states:
‘Applicants or drivers in whom a moderate or severe obstructive sleep apnea syndrome is suspected shall be referred to further authorised medical advice before a driving licence is issued or renewed. They may be advised not to drive until confirmation of the diagnosis. Driving licences may be issued to applicants or drivers with moderate or severe obstructive sleep apnea syndrome  who show adequate control of their condition and compliance with appropriate treatment and improvement of sleepiness, if any, confirmed by authorised medical opinion. Applicants or drivers with moderate or severe obstructive sleep apnea syndrome under treatment shall be subject to a periodic medical review, at intervals not exceeding 3 years for drivers of group 1 (i.e. non-commercial drivers) and 1 year for drivers of group 2 (i.e. commercial drivers), with a view to establish the level of compliance with the treatment, the need for continuing the treatment and continued good vigilance.’

fulltext:

http://onlinelibrary.wiley.com/doi/10.1111/jsr.12379/pdf

 

Global Strategy for Diagnosis, Management, and Prevention of COPD - 2016

In 2011, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) released a consensus report, Global Strategy for the Diagnosis, Management, and Prevention of COPD. It recommended a major revision in the management strategy for COPD that was presented in the original 2001 document. Updated reports released in January 2013, January 2014, January 2015, and December 2015 are based on scientific literature published since the completion of the 2011 document but maintain the same treatment paradigm. Assessment of COPD is based on the patient’s level of symptoms, future risk of exacerbations, the severity of the spirometric abnormality, and the identification of comorbidities. The January 2015 update added an Appendix on Asthma COPD Overlap Syndrome, material prepared jointly by the GOLD and GINA Science Committees.

The GOLD report is presented as a “strategy document” for health care professionals to use as a tool to implement effective management programs based on available health care systems. The quadrant management strategy tool is designed to be used in any clinical setting; it draws together a measure of the impact of the patient’s symptoms and an assessment of the patient’s risk of having a serious adverse health event in the future. Many studies have assessed the utility/relevance of this new tool. Evidence will continue to be evaluated by the GOLD committees and management strategy recommendations modified as required.

GOLD has been fortunate to have a network of international distinguished health professionals from multiple disciplines. Many of these experts have initiated investigations of the causes and prevalence of COPD in their countries, and have developed innovative approaches for the dissemination and implementation of the GOLD management strategy. The GOLD initiative will continue to work with National Leaders and other interested health care professionals to bring COPD to the attention of governments, public health officials, health care workers, and the general public to raise awareness of the burden of COPD and to develop programs for early detection, prevention and approaches to management.

Marc Decramer, MD
Chair, GOLD Board of Directors
Professor of Medicine
CEO University Hospital
University of Leuven, Leuven, Belgium

Claus Vogelmeier, MD
Chair, GOLD Science Committee
Director, Internal Medicine Clinic
University of Giessen and Marburg,
School of Medicine
Standort Marburg Baldingerstrasse
D-35043 Marburg, Germany

Link for free download:

www.goldcopd.org/uploads/users/files/GOLD_Report%202016.pdf

The bacterial pneumonias: a new treatment paradigm

Pneumonia is a common disease that carries a high mortality. Traditionally, pneumonia has been classified and treated according to the setting where the pneumonia develops, namely community-acquired pneumonia, health-care–associated pneumonia, and hospital-acquired pneumonia. This classification was based on the risk of a patient being infected with a hospital-acquired drug-resistant pathogen. 

A new treatment paradigm has been proposed based on the risk of the patient being infected with a community-acquired drug-resistant pathogen. The risk factors for infection with a community-acquired drug-resistant pathogen include (1) hospitalization for > 2 days during the previous 90 days, (2) antibiotic use during the previous 90 days, (3) nonambulatory status, (4) tube feeds, (5) immunocompromised status, (6) use of acid-suppressive therapy, (7) chronic hemodialysis during the preceding 30 days, (8) positive methicillin-resistant Staphylococcus aureus history within the previous 90 days, and (9) present hospitalization > 2 days. This article reviews this new treatment paradigm and other issues relevant to the diagnosis and management of pneumonia based on information from MEDLINE, EMBASE, and the Cochrane Register of Controlled Trials.
Fulltext:http://www.tandfonline.com/doi/abs/10.1080/21548331.2015.1001708?journalCode=ihop20

2016 Guidelines: obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

Today in ERJ was published European Respiratory Society on the diagnosis and management of obstructive sleep disordered breathing in childhood!

This document summarises the conclusions of a European Respiratory Society Task Force on the diagnosis and management of obstructive sleep disordered breathing (SDB) in childhood and refers to children aged 2–18 years. Prospective cohort studies describing the natural history of SDB or randomised, double-blind, placebo-controlled trials regarding its management are scarce. Selected evidence (362 articles) can be consolidated into seven management steps. SDB is suspected when symptoms or abnormalities related to upper airway obstruction are present (step 1). Central nervous or cardiovascular system morbidity, growth failure or enuresis and predictors of SDB persistence in the long-term are recognised (steps 2 and 3), and SDB severity is determined objectively preferably using polysomnography (step 4). Children with an apnoea–hypopnoea index (AHI) >5 episodes·h⁻¹, those with an AHI of 1–5 episodes·h⁻¹ and the presence of morbidity or factors predicting SDB persistence, and children with complex conditions (e.g. Down syndrome and Prader–Willi syndrome) all appear to benefit from treatment (step 5). Treatment interventions are usually implemented in a stepwise fashion addressing all abnormalities that predispose to SDB (step 6) with re-evaluation after each intervention to detect residual disease and to determine the need for additional treatment (step 7).

Fulltext:

http://erj.ersjournals.com/content/47/1/69?etoc