Hot in CHEST October 2016

By: Dr. Deep Ramachndran

October 14, 2016

Dr. Deep Ramachandran

Each 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 October, so let's hear from Dr. Ramachandran as he outlines his highlights. After reviewing the issue, be sure to share your hot list our Facebook wall, tweet with the hashtag #OctCHEST or discuss in the CHEST e-Community.


Relax and listen to the sound of us tooting our own horn

CHEST takes tremendous pride in the quality and depth of our clinical practice guidelines. They are put together by renowned experts in their respective fields who work tirelessly for no other compensation than helping to improve the quality of care. In this study, the quality of 15 different cough guidelines was reviewed using the AGREE II tool. Only CHEST Cough Guidelines were deemed “strongly recommended”; citing superiority in domains of rigor of development, clarity and presentation, applicability, and editorial independence.

An exciting time for asthma treatment

While treatment options for COPD have remained stubbornly static over the years, we appear to be entering a bit of a renaissance period in the treatment of asthma. The finding that IL-5 inhibition can reduce eosinophilic-induced inflammation has paved the way for new treatments that have the potential to improve the lives of patients with asthma. In this phase III study of reslizumab, we see meaningful improvements in asthmatics with blood eosinophil levels of > 400 cells/uL. I highly recommend reading the accompanying editorial; (link to editorial p. 766, please) it puts this study in perspective and gives a great overview of the current state of IL-5 inhibitor therapy.

Procalcitonin levels may predict need for ICU admission

We’re all acutely aware that pneumonia is a leading cause of death in the United States, accounting for $10 billion in hospital costs annually. We also know that inadequate treatment of pneumonia in its early stages can increase the risk of mortality. Thus, physicians are constantly looking for ways to help us determine the risks posed by the diagnosis of pneumonia in individual patients. This study suggests that we may be underutilizing something that’s already in our toolbox. Researchers found a nearly linear relationship between rising calcitonin levels and ICU level of care (use of pressors or intubation). These findings suggest that procalcitonin could be useful in evaluating patients admitted to the hospital with pneumonia.

Residence in medically underserved areas and its relationship to mortality in sepsis

It would not be surprising to most physicians that low socioeconomic status or living in a medically underserved area might increase one’s risk of disease. However it might be surprising to know that this study demonstrated an increased risk of sepsis-related mortality that was independent of sex, race, and traditional zip code-based surrogates. If this is truly the case, then as the authors suggest, being medically underserved could potentially be a modifiable risk factor in the fight against sepsis. Of course, now you’re probably asking, “but Deep, what are the four elements that define a medically underserved area?” Don’t worry! Check out the article for how being a medically underserved area is defined and some other interesting background info.

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