Conference Highlights: ATS 2017

Mortality & Respiratory Failure Timing

Few studies have assessed whether patients’ outcomes following respiratory failure that develops during hospitalization differ from those of patients who are admitted with respiratory failure. For a study, researchers from the Respiratory Compromise Institute in Virginia used Medicare claims data to analyze outcomes of patients admitted to short-term, acute care hospitals with respiratory failure and patients who developed respiratory failure during hospitalization. Patients who developed respiratory failure during hospitalization had an in-hospital mortality rate of 32.7%, compared with a rate of 27.8% for those who were admitted with respiratory failure. At 30 days after hospitalization, mortality rates were 15.3% for those who developed respiratory failure during hospitalization and 12.9% for those who were admitted with respiratory failure. Those who developed respiratory failure after hospitalization had comorbid congestive heart failure (45%), hypertension (38%), atrial fibrillation (35%), acute kidney failure (36%), pneumonia (31%), and septicemia (26%).

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First-Line Antibiotics for CAP Often Fail

Previous studies show that antibiotic failure for community-acquired pneumonia (CAP) is associated with significant morbidity, mortality, and expense. While pneumonia guidelines some direction on choosing first-line antibiotics for pneumonia, large-scale, real-world data are lacking to help optimize antibiotic choice and define factors associated with treatment failure. Data on adults who received antibiotic treatment following an outpatient visit for CAP were assessed for a study. The total antibiotic failure rate was 22.1%, determined by antibiotic switch (70.7%), antibiotic refill (20.6%), hospitalization (5.4%), and ED visit (3.3%). Pneumococcal pneumonia, older age, and female gender predicted antibiotic failure. Comorbid hemiplegia/paraplegia, rheumatologic disease, COPD, cancer, diabetes, and asthma were also associated with higher rates of antibiotic failure in patients with CAP.

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Patients & Provider Views on IPF Management

Prior research indicates that the majority of patients with idiopathic pulmonary fibrosis (IPF) do not receive approved antifibrotic therapy. Little is known regarding the varying viewpoints of IPF care among patients as well as among physicians with a “watch and wait” approach (WWP) or a proactive approach (PP). A 20-minute online survey was completed by patients with IPF and physicians who had consulted with more than five IPF patients in the past 3 months. Only 56% of patients reported receiving enough information at diagnosis. Most patients (86%) felt the ability of antifibrotic treatments to slow IPF progression was more important that side-effect profiles. At IPF diagnosis WWP were less likely to discuss prognosis than PP. Among patients with mild IPF, 62% and 38% were treated within 4 months of diagnosis with an antifibrotic by PP and WWP, respectively. WWP were more concerned with side effects, whereas PP were more concerned with disease progression.

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Mid-Life Respiratory Burden With Marijuana Use

Data comparing respiratory burden among never smokers and cigarette and/or marijuana smokers are lacking. For a study, more than 5,000 with an average age of 60 were categorized into never smokers, cigarette smokers, marijuana smokers, and dual (cigarette and marijuana) smokers. About 17% of never smokers experienced respiratory exacerbation-like illnesses in the past year, compared with about 19% of cigarette smokers, nearly 24% of marijuana smokers, and more than 24% of dual smokers. When compared with never smokers, cigarette smokers were significantly more likely to experience chronic cough, chronic phlegm, wheeze, dyspnea, and severe dyspnea, whereas marijuana smokers were only significantly more likely to experience wheezing.

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Variation in Treating COPD Exacerbations

Although COPD exacerbations are common and often associated with significant morbidity, little is known regarding which treatments are usually offered, and why, in real-world practices. To better understand the issue, study investigators analyzed the records of 658 COPD patients aged 40 or older who had at least two clinic visits at one of two clinics between June 2011 and June 2013. After adjusting for gender, medical insurance, change in sputum, and history of outpatient exacerbations, patients with dyspnea were 13.8 times more likely to receive steroids than those without dyspnea. After adjusting for a history of inpatient exacerbations, those with a change in sputum were 4.1 times more likely to receive antibiotics, and those with a history of outpatient COPD exacerbations were 1.8 times as likely to receive antibiotics.

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Predicting Asthma

Currently, pulmonary function testing to help diagnosis children is not an option until patients reach age 5. For a study, researchers examined the impact of viral acute respiratory infections (ARI) in the first year of life on future childhood respiratory health. Concentrations of the oxidative stress marker F2-isoprstane in the urine were measured soon after birth and then again during a viral ARI in 476 infants. Concentrations were significantly higher during viral ARIs among infants who developed recurrent wheeze when compared with those who did not. The study authors suggest that ARIs occurring very early in life can lead to oxidative stress in some infants that can, in turn, put those children a high risk of developing asthma later in childhood.