Virtual Visits by an RT Improve Asthma Outcomes

A paper published on the preprint server medRxiv.com suggests virtual visits by a respiratory therapist can lead to positive outcomes for people with asthma.

The pilot study, supported by the Louisiana Department of Health, sought to improve asthma outcomes in underserved areas during the pandemic. Patients enrolled in the program had poorly-controlled asthma, and among the 147 participants, 77% were children. In addition, non-Hispanic black participants made up 76% of the population, and 90% were from low or extremely low-income families.

Patients completed pre- and post-intervention knowledge tests, the Asthma Control Test (ACT), and a final survey assessing their perceptions of asthma management and environmental trigger reduction. In addition, all received asthma education materials, and 51 agreed to participate in up to three virtual visits with an RT.

Results showed improvement in asthma symptoms in all subjects, and scores on the ACT increased by a median of 2.39 points. Scores on the knowledge test also improved, with 86% of participants learning about at least one new asthma trigger. In addition, those assigned to the virtual visit group outperformed their peers. Seventy-five percent of the subjects reported feeling more empowered to control their asthma and said their quality of life had improved.

The authors believe these findings show that virtual visits can reach underserved communities and improve asthma symptoms. However, they say more study is needed to understand the barriers that keep those who qualify for such a program from participating. If access to technology is the issue, they suggest partnering with internet-capable community centers may be helpful. 

Early Mobilization for COVID-19 Patients on ECMO Pays Off

A new study out of Baylor Scott & White The Heart Hospital in Plano, TX, outlines the benefits of early mobilization for COVID-19 patients who are placed on ECMO.

The 18-month study compared 16 non-mobilized patients in a pre-intervention group with 26 patients in a post-intervention group. They pre-interview group had received received venovenous ECMO with strict bed rest, paralysis, and full sedation between May and December 2020. The post-intervention group had received early mobilization from January through November 2021.

The interprofessional approach, which involved physicians, advanced practice providers, ECMO specialists, nurses, respiratory therapists, pharmacists, and physical and occupational therapists, included earlier insertion of tracheostomies and quicker removal of isolation restrictions, followed by immediate weaning of NMBAs and sedatives. In addition, a modification in continuous infusion administration, use of oral or transdermal medications, and aggressive implementation of rehabilitation therapy sessions enabled the approach.

The survival rate of the post-intervention group was 73.1% vs. 43.8% for the pre-intervention group. Patients who received early mobilization also had fewer days of receiving paralytics, fentanyl, and midazolam, but more days of dexmedetomidine, morphine, and ketamine administration. Oral or transdermal analgesics, oral anxiolytics, and oral antipsychotics were also more common in the post-intervention group, and these patients required more single-site ECMO cannula adjustments.

The study was published by AACN Advanced Critical Care. 

Morphine Doesn’t Treat Severe Breathlessness in COPD Patients

Morphine does not help COPD patients deal with severe breathlessness, find researchers from Sweden and Australia who studied 156 patients over a three-week period. The patients were randomized into three groups in the first week, with two groups receiving regular low doses of once-daily morphine (8 milligrams daily or 16 milligrams daily). The third group received a placebo.

During the next two weeks, patients were randomized to receive an additional 8 milligrams of morphine or placebo in addition to the previous treatment. Again, the researchers and patients alike were blinded to which patients were in which groups.

Patients then rated their shortness of breath, and, using motion detectors, the investigators measured their physical activity as well. No differences were seen in the patient ratings of the worst breathlessness they experienced, and regular, low-dose morphine did not improve physical activity.

While the researchers believe these findings show no benefit for morphine in patients with COPD, they stop short of recommending discontinuation of use in those with severe breathlessness at rest or the end of life. “In most cases, our patients did not have shortness of breath at rest,” said study author Magnus Ekström. “Clinical experience shows that at the end of life and in crisis situations, morphine treatment can help.”

The study was published by JAMA. 

Early Screening for Lung Cancer Dramatically Improves Survival Rates

Does early-stage lung cancer diagnosis using low-dose computer tomography (CT) screening really impact lung cancer survival rates? According to researchers from Mount Sinai who presented their findings at the recent Radiological Society of North America meeting, the answer is a resounding yes.

The investigators looked at 1,285 patients who were diagnosed at an early stage using low-dose CT. Overall, the 20-year survival rate for these patients was 80%. The survival rate was 100% for the 139 participants how had nonsolid cancerous lung nodules and the 155 participants who had nodules with partly solid consistency. The survival rate for the 991 participants with solid nodules was 73%, and for those with Stage 1A cancers measuring 10 mm or less, it was 92%.

That compares to an average five-year survival rate of 18.6% for all lung cancer patients, a figure mainly attributed to the fact that only 16% of lung cancers are diagnosed in the early stages.

“While screening doesn’t prevent cancers from occurring, it is an important tool in identifying lung cancers in their early stage when they can be surgically removed,” said study author Claudia Henschke, PhD, MD, from the Icahn School of Medicine at Mount Sinai in New York. “Ultimately, anyone interested in being screened needs to know that if they are unfortunate enough to develop lung cancer, it can be cured if found early.”

Less than 6% of people eligible for an early screening take advantage of it. 

Persistent Asthma May Up Cardiovascular Risk

Persistent asthma may be considered a risk factor for cardiovascular disease. In a study conducted among a selected group of 5,029 adults enrolled in the Multi-Ethnic Study of Atherosclerosis, plaque was present in the carotid arteries of 67% of 109 people with persistent asthma, 49.5% of 388 people with intermittent asthma, and 50.5% of 4,532 people with no asthma.

Those with persistent asthma also had almost double the plaque as those with intermittent asthma or no asthma, and these participants had higher levels of inflammation when compared to those without asthma as well. Persistent asthma was defined as requiring daily use of medication to keep asthma under control. Ultrasound was used to measure plaque, and participants underwent blood tests to measure inflammation.

“This analysis tells us that the increased risk for carotid plaques among people with persistent asthma is probably affected by multiple factors,” said study author Matthew C. Tattersall from the University of Wisconsin in Madison. “Participants who have persistent asthma had elevated levels of inflammation in their blood, even though their asthma was treated with medication, which highlights the inflammatory features of asthma. We know that higher levels of inflammation lead to negative effects on the cardiovascular system.”

The study was published by the Journal of the American Heart Association. 

Cystic Fibrosis Cases Dropping

Genetic testing, newborn screening, and the population’s increased diversity may contribute to a drop in the annual number of cystic fibrosis cases seen in the U.S. and Canada, report researchers publishing in the Journal of Cystic Fibrosis.

From 1995 to 2019, the incidence of CF declined by 1.6% per year in both countries. However, that decline has varied depending on the region in each country.

The investigators believe genetic testing and newborn screening may be behind the reduction in cases because those two factors may be causing people who carry the CF gene to have no or fewer children. In addition, since CF is more commonly found in people of European descent, more significant immigration from other countries could also be influencing the rate.

The authors believe this information can help with resource planning for cystic fibrosis patients, nearly three-quarters of whom will be adults in the U.S. by 2040, as well as tracking how programs like genetic testing may impact the CF population in the future.