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Hot in Journal CHEST® June 2018

By: Chris Carroll, MD, FCCP

Dr. Chris CarrollEach month, we ask Drs. Chris Carroll and Deep Ramachandran, Social Media Co-Editors of CHEST, to weigh in on the hot topics in CHEST. It's June, so let's hear from Dr. Carroll as he outlines his highlights. After reviewing the issue, be sure to share your hot list on our Facebook wall, tweet with the hashtag #journalCHEST, or discuss in the CHEST LinkedIn group.

Just in time for summer, there’s a new issue of CHEST®! There are some great articles this month! Here are some of my top picks. 

Direct to Consumer Marketing of Unproven Stem Cell Treatments for Lung Disease 

In an editorialin this month’s CHEST, Dr. Marilyn Glassberg and colleagues highlight an important public health issue—the direct to consumer marketing of unproven stem cell treatments. In this increasingly “post-truth” era, frequently those with the loudest voices control the message. And direct to consumer marketing can provide a loud voice. 

Suffering patients are particularly prone to promises of miracle cures. Worldwide more than 60,000 people have been treated at stem cell clinics. Like the snake-oil salesmen of the past, these clinics exaggerate safety and efficacy, delivering unproven and potentially dangerous treatments at exorbitant costs. In this editorial, Dr. Glassberg and colleagues detail the science behind why these therapies are so dangerous. Kudos for their detailed callout of this despicable practice. 

Beta-Blockers in COPD: A Cohort Study From the TONADO Research Program

A large number of patients with COPD also have cardiovascular disease (and vice versa). Because of these comorbidities, providers often have to weigh the risks and benefits of medications that may have different and potentially conflicting effects on their disease states. For example, some physicians are reluctant to use beta-blockers in patients with COPD despite proven benefits for cardiovascular disease, due to concern that these medications will adversely affect their COPD. 

To address these concerns, Dr. François Maltais and colleagues conducted a post-hoc analysis of the TONADO studies in a studypublished in this month’s CHEST. In a cohort of more than 5,000 patients treated with tiotropium/olodaterol, the authors found that lung function, overall respiratory status, and incidence of adverse events were similar in patients with COPD treated with beta-blockers and those not treated with beta-blockers. The authors concluded that this supports cautious use of beta-blockers in patients with COPD who also have cardiovascular disease. 

The Association of Frailty With Post-ICU Disability, Nursing Home Admission, and Mortality: A Longitudinal Study

Finally, in this month’s CHEST, Dr. Lauren Ferrante and colleagues published an outstanding prospective studyexamining the association between frailty and outcomes in the ICU. Frailty is a clinical syndrome that is not uncommon in older adults and is a strong predictor of vulnerability and poor health outcomes. However, the association between frailty and ICU outcomes has not been previously studied.

More than 750 adults over 70 years were prospectively evaluated for disability and for frailty over a 16-year period. There were 391 ICU admissions in this population, and frailty or pre-fraility was present in more than half of these admitted patients. Frailty was associated with double the likelihood of death and was also associated with an increased risk of post-ICU disability and new nursing home admission. Kudos to Dr. Ferrante and colleagues for highlighting this important factor to consider in the care of our elderly patients.