Most recently added articles listed first
Comment by Dr Mark Lavercombe:
Indwelling pleural catheters (IPCs) have become part of the standard of care of malignant pleural effusions, although concerns about potential for IPC-related infections persist. Inspired by guidelines for the management of peritoneal dialysis catheters recommending topical mupirocin application at the catheter site, this study explores whether IPCs are affected by the application of topical mupirocin, and whether this is feasible as part of IPC care. In seven IPCs treated with mupirocin, no concerning structural changes were observed in up to six months of observation. Mupirocin application in patients with IPCs was tolerated well. Further studies to evaluate efficacy in preventing infection will be required.
Comment by Dr Mark Lavercombe:
In this systematic review and meta-analysis, the authors examine the imaging and pulmonary function sequelae of COVID-19 infection at twelve months. In the 15 articles included, residual abnormalities on chest CT at twelve months were present in approximately one third of patients. The most common findings were ground glass opacity, fibrotic-like changes and bronchiectasis. Residual abnormalities were more common in patients classified as having had severe/critical COVID-19 infection. The most common abnormality at pulmonary function testing was reduced DLCO in around 30% of patients, again more frequently in those who had had severe/critical COVID-19 infection. Given the enormous burden of the COVID-19 pandemic, longitudinal follow-up data like these are critical to inform clinical practice and service planning.
Home monitoring of lung function, symptoms and quality of life after admission with COVID-19 infection: The HOMECOMIN' study
Gizal Nakshbandi, Catharina C Moor, Esther J Nossent, J J Miranda Geelhoed, Sara J Baart, Bart G Boerrigter, Joachim G J V Aerts, Suzan F M Nijman, Helger Y Santema, Merel E Hellemons, Marlies S Wijsenbeek (DOI: 10.1111/resp.14223)
onlinelibrary.wiley.com/doi/10.1111/resp.14262/full (July 2022)
Comment by Dr Mark Lavercombe:
Although the COVID-19 pandemic remains an active issue in most countries and the demand for inpatient care might remain elevated for some time, the burden of disease in patients in outpatient settings is still being appreciated. In this paper, the authors use home monitoring of spirometry, pulse oximetry and a variety of questionnaires and visual analogue scales on a series of patients after their hospital discharge - 42% of whom required ICU level care - to plot their recovery over time. The findings are useful in helping us appreciate the natural history in this cohort, although further data is needed from a range of different settings and patient groups to feel more confident in their generalisability.
Comment by Dr Mark Lavercombe:
Many will have suspected that infections other than with the SARS-CoV-2 virus would have reduced during periods of strict contact restrictions, and this paper from New Zealand confirms reductions in infective respiratory admissions, including pneumonia, COPD and asthma during Winter of 2020. Non-infective respiratory diagnoses such as lung cancer, pulmonary embolism and pneumothorax did not decline. Although observational, these data suggest support for measures such as self-isolation when symptomatic with viral respiratory tract infections.
Comment by Dr Mark Lavercombe:
In this paper, the authors apply a retrospective target trial emulation on a large dataset of patients with sarcoidosis from Sweden, to examine the difference in infection rates between those treated with methotrexate and azathioprine for their steroid-sparing effect. Their findings suggest an initial reduction in relative infection risk in those treated with methotrexate, although the difference reduced over time. Prospective data is needed to confirm this finding.
Comment by Dr Mark Lavercombe:
The authors of this paper demonstrate that in the five years after an initial episode of protracted bacterial bronchitis, almost 70% of children have ongoing symptoms, 27% have clinician-diagnosed asthma and 10% have developed bronchiectasis. They identify children at particular risk of progression and recommend follow-up strategies to mitigate the future risk.
Comment by Dr Mark Lavercombe:
In this study the authors demonstrate associations between sputum bacterial community characteristics and both structural and clinical measures in patients with bronchiectasis. Increase in blood inflammatory markers levels correlated with lower bacterial diversity, while reduced bacterial diversity, richness and evenness were associated with structural abnormalities on HRCT. The authors suggest a potential role for pathogenic bacterial dominance contributing to disease state.
Comment by Dr Mark Lavercombe:
Vocal cord dysfunction is not uncommon in patients after lung cancer resection, and this study demonstrates a significant association with poor post-operative outcomes including pneumonia, need for bronchoscopy and re-intubation. The authors recommend routine laryngeal screening within 24h of surgery, although treatment outcomes were not assessed in this study.
Comment by Dr Mark Lavercombe:
Bronchoscopy with bronchoalveolar lavage is often required for immunosuppressed patients presenting with lung infiltrates. This study compares the diagnostic yield for respiratory virus PCR on nasopharyngeal and BAL specimens, and demonstrates both high concordance and low false negative rate for nasopharyngeal specimens.
Comment by Dr Mark Lavercombe:
This paper demonstrates a significant relationship between levels of cardiac troponin measured at admission in patients with Community-Acquired Pneumonia and both 30-day and long-term mortality. The combination of Pneumonia Severity Index with Troponin level predicted mortality better than either model alone. These findings suggest cardiac evaluation might be worthwhile in patients with CAP and elevated Troponin.
Comment by Dr Mark Lavercombe:
This study demonstrates a potential correlation between childhood pneumonia and exposure to solid fuel burning. Future work might examine whether reduction in indoor biomass pollution will lead to reduction in early childhood pneumonia.
Pseudomonas aeruginosa antibiotic resistance in Australian cystic fibrosis centres. Smith et al.
onlinelibrary.wiley.com/doi/10.1111/resp.12714/abstract (Dec 2015)
(FREE access: Editor's Choice; Editorial: onlinelibrary.wiley.com/doi/10.1111/resp.12721/abstract)
Systematic review and meta-analysis of respiratory viral coinfections in children. Lim et al.
onlinelibrary.wiley.com/doi/10.1111/resp.12741/abstract (Feb 2016)
Randomized controlled trial of the effect of regular paracetamol on influenza infection. Jefferies et al.
onlinelibrary.wiley.com/doi/10.1111/resp.12685/abstract (Dec 2015)
(FREE access: Editor's Choice; Editorial: onlinelibrary.wiley.com/doi/10.1111/resp.12726/abstract