*Denotes Canada-based study
LUNG CANCER AND TOBACCO USE
Lung Cancer Mass Predicts Brain Metastases (Poster 484, Exhibit Hall, Wednesday, November 2, 12:30 PM -2:00 PM)
In patients with non-small cell lung cancer (NSCLC) the size of a patient's lung mass is correlated with the presence of brain metastases. After reviewing the CT chest scans of 35 patients with NSCLC, who had brain metastases, and 35 others without brain metastases, researchers at St. Joseph's Regional Medical Center, New Jersey, discovered that the presence of lung mass equal to or greater than 3.9 cm predicts the presence of brain metastases.
School Sports Decrease the Likelihood of Smoking(Poster 628, Exhibit Hall, Wednesday, November 2, 12:30 PM -2:00 PM)
Students who are active in sports are significantly less likely to smoke cigarettes than other students, according to a new study out of Charleroi, Belgium. A questionnaire on smoking, knowledge of tobacco risks, and the impact of media and school on smoking habits was completed by 208 students (ages 14 to 20 years) in a Belgium school. Of the students involved in less than 3 hours of sports per week, 70 percent of the boys smoked and 66 percent of the girls smoked. These smoking rates dropped to 64 percent of boys and 57 percent of girls among the students who participated in sports for 8 or more hours per week. Survey results also show that the media's messages about tobacco have a bigger impact on students than messages they are taught in school.
Quitting Smoking Improves Performance, Not Survival, in Patients With Lung Cancer(Poster 106, Exhibit Hall, Wednesday, November 2, 2005, 12:30 PM-2:00 PM)
In a study of 206 patients with lung cancer, 93 (45 percent) were smokers, 14 (7 percent) were nonsmokers, and 98 (48 percent) were former smokers. After reviewing clinical characteristics, smoking history, comorbidities, survival, performance status, and pulmonary function tests, researchers from the University of Texas MD Anderson Cancer Center, Texas, found there was no significant difference between survival rates, based on smoking status before and after diagnosis. Patients who quit smoking maintained a better performance status at 6 and 12 months following diagnosis.
*Improved At-home Method to Diagnose and Treat Sleep Apnea(Poster 155, Exhibit Hall, Wednesday, November 2, 2005, 12:30 PM-2:00 PM)
There may be a more accessible and cost-effective method to diagnose and treat obstructive sleep apnea (OSA) than the traditional method of overnight polysomnography (PSG). Researchers at HÃ´tel-Dieu of CHUM (MontrÃ©al, Canada) conducted full PSG studies on 25 tetraplegic patients in their homes and 25 surgical patients in the hospital. At a later time, the analysis was repeated using only respiratory variables (without EEG and EMG signals). Through calculating the number of respiratory events per hour, and without using bioelectric signals, researchers were able to arrive at significantly similar sleep scores using both testing methods. Researchers believe this new method of testing for sleep apnea will save patients money and be more accessible, while returning similar results as traditional testing.
Sleep Apnea Prevalent in Nonobese(Convention Center, Room 514B, Monday, October 31, 2005, 10:30 AM -12:00 PM)
In a study of 270 patients with obstructive sleep apnea (OSA), researchers from the Walter Reed Army Medical Center, Washington DC, and the Greater Washington Sleep Disorders Centers, Maryland, compared the OSA severity of 120 active-duty military, of whom 19.3 percent were obese, 80 National Guardsmen, of whom 48.8 percent were obese, and 70 civilians, of whom 64.3 percent were obese. Researchers found that the prevalence of severe disease did not differ between the groups, and age and sleep apnea scores had a low correlation, indicating that OSA should be considered for patients, regardless of their weight and age.
Nonobese Patients With Sleep Apnea Use More Sedatives(Poster 162, Exhibit Hall, Wednesday, November 2, 2005, 12:30 PM -2:00 PM)
A study of 102 patients with OSA shows that 1 in 5 patients with OSA are nonobese (16.7 percent), and these patients are more likely to use sedatives. Differences found between the obese and nonobese patients included nonobese patients being older (57.1 years on average, compared to 48.3 years) and exhibiting less upper airway narrowing. This is also the first study to show that nonobese patients with OSA were significantly more likely use excess sedatives, when compared to obese patients with OSA, with 52.9 percent of nonobese patients using one or more sedatives, compared to 24.7 percent of obese patients. The study's researchers from Marshall University, West Virginia, emphasize the importance of screening nonobese patients for OSA.
Snoring Common Among Young Women With Allergies(Convention Center, Room 515B, Wednesday, November 2, 2005, 10:30 AM-12:00 PM)
Young women with atopy (allergies to pollen, food, dander venoms, etc) are more likely to snore, according to researchers from the Cincinnati Children's Hospital Medical Center (Cincinnati, OH) and the University of Cincinnati (Cincinnati, OH). After completing a questionnaire about snoring frequency and smoking status and having a skin prick test to determine allergies to 15 aeroallergens, 515 women, with an average age of 29.8 years, were compared to identify snoring risk factors. Results show that 257 (49.9 percent) never snored, 176 (34.2 percent) snored at least 1 night a week, and 105 (20.4 percent) snored at least three times per week. Patients in this group who smoked were almost twice as likely to snore regularly (34.0 percent vs 18.2 percent), and African-Americans were also more likely to smoke (29.1 percent vs 18.5 percent).
ASTHMA AND LUNG FUNCTION
*Doctors Prescribe Asthma Meds Based on Insurance Type(Poster 195, Exhibit Hall, Wednesday, November 2, 2005, 12:30 PM -2:00 PM)
The type of asthma medication prescription patients receive from their physician often differs based on whether they have public or private insurance. In a questionnaire distributed to 284 general practitioners from across Canada by researchers at Dalhousie University (NS, Canada) and GlaxoSmithKline (ON, Canada), physicians were asked about their prescribing preferences for patients with uncontrolled asthma currently taking moderate doses of inhaled corticosteroids (ICS). Although increasing the ICS dose in this situation conflicts with the current national guidelines for asthma management, 22 percent of physicians said they would increase the dose for patients with private coverage, while 37 percent of physicians reported that they would increase the dose for patients with public coverage.
*Canadian Asthma Study Finds Nationwide Asthma Confusion(Poster 190, Exhibit Hall, Wednesday, November 2, 2005, 12:30 PM -2:00 PM)
A nationwide survey of Canadians with asthma shows that although asthma greatly impacts their lives, patients with asthma are largely uninformed when it comes to asthma control. In a telephone survey conducted by researchers at Dalhousie University (NS, Canada), York Finch Medical Centre (ON, Canada), Asthma Society of Canada (ON, Canada), and Mount Sinai Hospital (ON, Canada), researchers found 997 Canadian patients with physician-diagnosed asthma; 10 percent of patients had been treated in the emergency department in the last year; and 12 percent had missed work or school because of asthma. Ninety-seven percent of patients said that asthma affected their work or school performance, 28 percent reported daily daytime symptoms, and 67 percent reported daytime symptoms at least weekly. Yet, 70 percent of patients had not had their inhaler technique checked, and only 50 percent of patients had objective pulmonary function tests. Patients were also unclear about controller medications, as 39 percent reported using short-acting bronchodilators as their most often used "controller" medication, and another 15 percent did not know which of their medications were "controllers."
Daily Nasal Spray Controls Asthma, Saves Money(Poster 174, Exhibit Hall, Wednesday, November 2, 2005, 12:30 PM -2:00 PM)
Using daily nasal steroids and HT1 blockers for asthma can dramatically improve asthma symptoms, while reducing cost and the amount of medications needed. In a review of Blue Shield Puerto Rico records for claims paid in 2004, researchers from the Asthma Management Center, Puerto Rico, looked at 358 patients who were referred to an asthma management center and compared them to a control group of 12,070 asthmatics treated elsewhere. Patients were given daily nasal steroids, instructions in the use of peak expiratory flow and logging, inhaled bronchial medication, and emergency albuterol inhalations. Of the patients taking daily nasal steroids and HT1 blockers, there was a significant decrease in peak-flow readings, use of controller medications, dollars spent on medications, and an 88% drop in number of hospital admissions for asthma.
Common Reasons for Not Taking Asthma Meds Don't Hold Up(Convention Center, Room 514C, Tuesday, November 1, 2005, 12:30 PM-2:00 PM)
Financial and access barriers to health care are frequently cited reasons for people not taking prescribed medications; however, a new study shows that many patients do not refill their medication, even when these barriers are removed. When researchers from the University of Alabama at Birmingham and the Children's Hospital of Alabama provided 296 children with asthma (ages 6 to 13) in Birmingham, AL, with free rescue and controller medication and instructed them to call in for a refill, the overwhelming majority did not. To date, 213 children (72 percent), have never refilled their controller medication, and only 36 children (17 percent) have refilled their prescription at the expected rate.
Lung Function Varies With Season (Convention Center, Room 513F, Tuesday, November 1, 2005, 10:30 AM-12:00 PM)
In areas with four distinct seasons, lung function is best in the winter and worst in the summer. New York researchers at Long Island Jewish Medical Center performed pulmonary function tests on 4,486 people over a 4-year period. The lung function data was divided into four groups based on when the tests were done, with 1,118 conducted from January to March, 1,281 from April to June, 1,080 from July to September, and 1,007 from October to December. Results show that FEV and DLCO values were significantly decreased during the summer months of July to September. Researchers say these findings coincide with the common complaint that respiratory symptoms get worse when the weather changes.
Aspirin May Not Be Best Following Heart Surgery (Poster 240, Exhibit Hall, Wednesday, November 2, 2005, 12:30 PM-2:00 PM)
While aspirin therapy within 24 hours of off-pump coronary artery bypass grafting (OPCAB) is standard, new study results show that this treatment may do more harm than good. Researchers at Escorts Heart Institute and Research Center in New Delhi, India, looked at data from 750 patients who underwent OPCABG. One group received aspirin within 24 hours of surgery, and the other group received a placebo. The study results indicate that early aspirin therapy may not be beneficial in preventing postoperative inflammatory injury but, instead, may increase adverse outcomes, including, increased bleeding, blood/blood product requirement, and re-exploration.
Missing Teeth is an Indicator of Arterial Hardening(Poster 280, Exhibit Hall, Wednesday, November 2, 2005, 12:30 PM-2:00 PM)
Researchers have discovered a link between the number of teeth someone is missing and atherosclerosis. Researchers at Downstate Medical Center in New York counted the number of missing teeth in 115 patients referred for transesophageal echocardiography (TEE) to determine whether they had periodontal disease and measured maximal aortic plaque thickness by TEE. Results show that age is the strongest predictor of aortic atherosclerosis. Other independent predictors include dental loss and calcium-channel blocker use.
Vibroacoustic Disease May Lead to Autoimmune Situations (Poster 283, Exhibit Hall, Wednesday, November 2, 2005, 12:30 PM-2:00 PM)
Researchers at the Pediatric Cardiac Surgical Unit, Santa-Marta Hospital (Portugal), the Abel Salazar Institute for Biological Sciences, University of Porto (Portugal), the Department of Environmental Sciences and Engineering, Portugal, and the Center for Human Performance (Portugal) removed and studied pericardial fragments from patients with vibroacoustic disease (VAD) who were about to undergo cardiac surgery to determine the nature of abnormal thickening. While normal pericardia have three layers, five layers were present, all with a large amount of cellular debris that may lead to autoimmune situations. Researchers conclude that pericardial thickening can be the cause of autoimmune situations.
DrotAA Reduces Risk of Cardiac Events in Patients With Sepsis (Poster 599, Exhibit Hall, Wednesday, November 2, 2005, 12:30 PM-2:00 PM)
Patients with sepsis who take drotrecogin alfa (activated) (DrotAA) have a significantly reduced rate of cardiac events. Researchers from Akron General Medical Center, in Ohio, the Robert Wood Johnson Medical School, in New Jersey; Cochin Hospital University, in France; the Service des Urgences et des Soins Intensifs, in Belgium; the University of Miami, in Florida; George Washington University, in Washington, DC; the Centre Hospitalier Victor Dupo, in France; Sabadell Hospital, in Spain; and Eli Lilly and Company, in Indiana, evaluated serious adverse events (SAEs) from 4,459 patients with sepsis included in INDEPTH, a database of five clinical trials. They reviewed data of 3,228 patients treated with DrotAA and 1,231 patients treated with placebo. Patients taking DrotAA had a higher survival rate and lower rates of heart attacks and arrhythmia during infusion period and at 28 days. Both groups had similar SAE rates overall.
Long-term Use of Sildenafil for Hypertension Has Positive Outcomes(Convention Center, Room 514B, Tuesday, November 1, 2005, 10:30 AM-12:00 PM)
Sildenafil was given to 14 unstable, patients with WHO Class IV pulmonary arterial hypertension (PAH) who were admitted to the hospital with severe right heart failure (RHF) by researchers at the University of Southern California. The patients' therapies included sildenafil, digoxin, diuretics, and inhaled nitric oxide. After receiving treatment with sildenafil for at least 4 weeks, patients experienced an average 6-minute walking distance increase of 122.4 meters, which increased to 351 meters after 6 months of treatment. After 1 year, 13 patients who remained on sildenafil and were WHO Class II-III were without signs of RHF. The study shows a significant association between the length of time a patient takes sildenafil and improvements in 6-minute walking distance, oxygen requirements, and WHO classification status.
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
*Spirometry Screening Recommended for Inner-city Adults(Convention Center, Room 513F, Monday, October 31, 2005, 10:30 AM-12:00 PM)
Adults living in Vancouver's inner city were found to have a high prevalence of undiagnosed obstructive lung disease (OLD), according to researchers from Vancouver Coastal Health Authority (BC, Canada), Charles Sturt University (Australia), and the University of British Columbia (BC, Canada). Of 300 adult cigarette smokers, 10.7 percent had OLD according to Canadian Thoracic Society criteria, and 31 percent had OLD according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) or American Thoracic Society/European Respiratory Society criteria. Although respiratory symptoms were common, including chronic cough (64 percent), chronic sputum (62 percent), wheezing (59 percent), and shortness of breath with activity (69 percent), only 22 percent of participants with irreversible OLD reported a physician diagnosis of chronic bronchitis, COPD, or emphysema. Researchers recommend that inner-city smokers, who are at least 35 years old, undergo spirometry screening for early detection of COPD.
*Group Learning Improves Knowledge of End-of-Life Care(Convention Center, Room 515C, Tuesday, November 1, 2005, 12:30 PM -2:00 PM)
In a study of Canadian medical and residency students at the University of Alberta (AB, Canada), 100 percent agreed that "end-of-life management is an important part of health care;" yet all students felt end-of-life care was not well represented in training. All study participants said they would recommend small group sessions as a learning tool for improving end-of-life care for patients with COPD after participating in end-of-life care, case-based, small group discussions.
*Psychiatric Disorders Common in Women with COPD(Poster 101, Room Exhibit Hall, Wednesday, November 2, 2005, 12:30 PM -2:00 PM)
A total of 116 patients with COPD were tested (54 men and 62 women), and 57 percent of women and 35 percent of men were classified as having one or more anxiety disorders, the most common being panic disorder. Thirty-one percent of women and 14 percent of men were classified as having one or more mood disorders, the most common being major depression. While women and men had similar dyspnea scores and no difference in exacerbation rates or lung function, women showed significantly greater psychological distress, worse perceived control of symptoms, and worse disease-related quality of life. A new study out of SacrÃ©-Coeur Hospital (MontrÃ©al, Canada), the MontrÃ©al Heart Institute (MontrÃ©al, Canada), and the University of QuÃ©bec at MontrÃ©al (MontrÃ©al, Canada) found that psychiatric disorders are at least three times higher in patients with COPD than in those without the disease, and the rates are three times higher for women than men.
Farm Exposures Frequently Cause COPD(Convention Center, Room 514A, Wednesday, November 2, 2005, 10:30 AM-12:00 PM)
Although smoking is the main cause of COPD, new research shows that patients with COPD frequently have a history of agricultural exposures. Researchers at the Omaha Veteran's Administration Hospital, Omaha, NE, administered a telephone survey to 150 veterans with COPD and found that 68 percent had a history of agricultural exposure. Of these, histories of agricultural exposures included dairy farms (30 percent), hog confinement barns (21 percent), and poultry farms (12 percent). The researchers from the University of Nebraska Medical Center and the Department of Veterans Affairs Medical Center, in Nebraska, suggest that agricultural exposures be included in the health-care analysis of patients living with COPD living in rural areas.
Sepsis Risk Higher for Patients with COPD(Poster 604, Exhibit Hall, Wednesday, November 2, 2005, 12:30 PM-2:00 PM)
With data from 15,586 patients included in the Atherosclerosis Risk in Communities (ARIC), as well as up to 11 years of follow-up data, researchers identified patients with COPD, pneumonia, and sepsis. The analysis shows that patients with COPD are more likely to get sepsis, but the risk was dramatically reduced after controlling for pneumonia. Researchers from the University of Kentucky conclude that pneumonia is a very strong predictor of sepsis in patients with COPD.
GENDER AND AGE DIFFERENCES IN MEDICINE
Arterial Catheter Attempt Failures Seven Times Greater for Women(Convention Center, Room 515A, Tuesday, November 1, 2005, 2:30 PM-4:00 PM)
Female patients have significantly higher failure rates for arterial line attempts than male patients. In a study of 92 consecutive arterial catheter attempts over a 5-month period, by researchers at Beth Israel Medical Center, in New York, the overall failure rate was in 26 of 92 attempts. The failure rate for women was 24 out of 56 attempts (43 percent), compared to only 2 out of 36 attempts for men (6 percent). Researchers speculate that smaller arterial size in women may make arterial catheter attempt failures more likely.
Cough May Be Responsible for Pneumonia and Respiratory Infections in Seniors(Poster 358, Exhibit Hall, Wednesday, November 2, 12:30 PM-2:00 PM)
An increasingly desensitized cough reflex may explain why people are more likely to get pneumonia and respiratory tract infections (RTIs) as they age. Researchers from the University of South Florida administered multiple breathing-related tests to 26 patients (17 ages 18 to 27, and 10 ages 67 to 77). Results show that patients in the older group had higher levels of exhaled nitric oxide, an indication of airway inflammation. Patients in the older group also required more capsaicin doses for cough initiation and had higher carbon (C2) levels.
INTERNATIONAL HEALTH ISSUES UPDATE
Tsunami Health Effects and Treatments(Convention Center, Room 515B, Monday, October 31, 2005, 10:30 AM-12:00 PM)
Soft tissue and musculoskeletal infections are more common than respiratory tract infections among survivors of the tsunami. Of an analysis of 30 patients who had been hospitalized, researchers at Samitivej Srinakarin Hospital, in Thailand, found 27 patients had soft tissue and musculoskeletal infections (90 percent), 10 people had respiratory tract infections (33 percent), 10 patients had polymicrobial Gram-negative infections, and 6 people had multiple sites of infection (20 percent). The average hospital stay was 4 days. The most effective treatments for infectious complications related to submersion injuries from seawater are beta-lactam antibiotics or fluoroquinolones and removing foreign material via surgical debridement and endoscopy.
Long-term Health Effects of SARS(Convention Center, Room 514C, Monday, October 31, 2005, 2:30 PM-4:00 PM)
SARS has harmful long-term effects on survivors' pulmonary function, exercise capacity, and health-related quality of life, according to a study of 86 survivors of SARS (27 men and 59 women) at the Chinese University of Hong Kong, in Hong Kong, PRC. After 18 months of first acquiring the illness, the exercise capacity and health status of patients with SARS were much lower than normal, and 27.9% of patients had suffered from significant impairment in diffusing capacity. In addition, while 6-minute walk distance times had improved from 3 months to 12 months, no additional improvements were seen after 18 months.
9/11 New York Fire Department Workers' Health (Convention Center, Room 514A, Wednesday, November 2, 2005, 10:30 AM-12:00 PM)
A year after September 11, 2001, a total of 12,079 New York Fire Department (FDNY) rescue workers had reduced lung function as a result of the World Trade Center (WTC) dust exposure. Rescue workers' before and after 9/11 pulmonary function scores were compared and analyzed in relationship to WTC dust exposure intensity by researchers at Albert Einstein College of Medicine, in New York, the University of New York, and New York City Fire Department, in New York. Lung function decline was greatest for rescue workers with early, high exposure and was over twice that of nonexposed workers. Lung function decline was strongly correlated with the amount of exposure and the type of work assignment performed.
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CHEST 2005: International Scientific Assembly of the American College of Chest