A study found in the open access journal PLoS Medicine reveals that a protein called angiopoietin-2 (Ang-2) might play a pivotal role in acute respiratory distress syndrome (ARDS), a condition that affects about 40% of patients with sepsis and worsens their prognosis.

The results of the study suggest that Ang-2 can serve as a marker of acute lung injury and might be a key player in sepsis-associated ARDS. Beyond that, the results also raise the possibility that reducing Ang-2 levels in patients might help to prevent or improve this dangerous complication in patients with sepsis. Future studies in patients with sepsis and in patients with ARDS that is not caused by sepsis are needed to clarify the roles of Ang-2 in ARDS and the suitability of Ang-2 as a target for therapy. The study, “Excess Circulating Angiopoietin-2 May Contribute to Pulmonary Vascular Leak in Sepsis in Humans” by Parikh S, Mammoto T, Schultz A, et al, appears in PLoS Med. 2005;3(3):e46.

Effective, Cheap Treatment for Cystic Fibrosis

In a collaborative effort, two teams of medical scientists have identified what they believe is a simple, effective, and inexpensive treatment to reduce lung problems associated with cystic fibrosis. The new therapy, identified through studies supported chiefly by the Cystic Fibrosis Foundation and the National Heart, Lung and Blood Institute, also appears to be safe and easy to take. The treatment significantly improved mucus clearance, lung function, and breathing symptoms.

By inhaling a saltwater aerosol solution for between 10 and 15 minutes at least twice a day, young patients should be able to avoid a significant part of the damage the disease causes to their lungs, the researchers said. That is because the aerosolized saltwater restores the thin lubricant layer of water that normally coats airway surfaces. This water layer promotes the clearance of the naturally occurring mucus the body uses to trap harmful bacteria, viruses, and other foreign particles. This research is important not only for its immediate application but also because it provides the road map for development of future effective therapies for CF, said Richard C. Boucher, MD, professor and director of the Cystic Fibrosis Research and Treatment Center. This study appears to establish the concept that the surfaces of the lungs of CF patients are dehydrated, and restoring hydration with hypertonic saline treats the basic cause of this disease. Reports on both studies appear in the January 19, 2006, issue of the New England Journal of Medicine.

Inhaled Medicine Improves Survival for Lung Transplant Patients

An inhaled antirejection drug can dramatically improve survival after a lung transplant, according to a study conducted at the University of Pittsburgh and led by lung disease specialists who are now at the University of Maryland in Baltimore. The results of the study are published in the January 12, 2006, edition of the New England Journal of Medicine. The study, a double-blind, placebo-controlled trial conducted in lung transplant patients, tested an inhaled form of cyclosporine, a widely used medicine to prevent organ rejection following a transplant. “Inhaled cyclosporine is the first drug ever to show a decline in the incidence of chronic rejection—the leading cause of death following a lung transplant,” says lead author Aldo T. Iacono, MD, medical director of lung transplantation at the University of Maryland Medical Center and associate professor of medicine at the University of Maryland School of Medicine.

Of the 26 patients in the study who received the inhaled cyclosporine, 23 were still alive 2 years later. Of the 30 patients in the placebo group, only 16 were alive at the 2-year point. The researchers report that the death rate in the cyclosporine group was 11% during the study compared to 47% for the placebo group.

“Conventional antirejection drugs, which are given orally, do not get into the small air sacs of the lungs where chronic rejection takes place,” says Bartley Griffith, MD, professor of surgery and chief of the Division of Cardiac Surgery at the University of Maryland School of Medicine. “It just makes a lot more sense to give a higher concentration of the drug right into the area you are trying to treat. Organ-specific immune suppression is almost a new paradigm for transplantation.”

Triage Plan Seeks to Set Mechanical Ventilation Guidelines

An article in the February 2006 issue of Academic Emergency Medicine, the journal of the Society for Academic Emergency Medicine, outlines a sample set of guidelines for prioritizing the use of mechanical ventilators in the case of a pandemic. The guidelines, still in a preliminary stage of development, propose three tiers of criteria for triage. The first two tiers list criteria for withholding and withdrawing ventilatory support; the third tier comprises specific protocols to be agreed upon by a guideline development committee. “We need to start talking about this now and develop a fair process so that, in a crisis, a mechanism is in place to apply the best science we have to make the best use of the available resources,” said John L. Hick, MD, who along with Daniel T. O’Laughlin, MD, is proposing the guidelines. “Although our plan is not definitive, we hope it will serve as the starting point for a discussion that needs to be had.”

Smoking During Pregnancy May Affect Baby’s Fingers and Toes

There is one more reason not to smoke during pregnancy. A mother’s cigarette smoking increases the risk that her newborn may have extra, webbed, or missing fingers or toes, according to a study in the January issue of Plastic and Reconstructive Surgery.

While the risk of these abnormalities in fingers and toes is relatively low, just half a pack of cigarettes per day increases the risk to the baby by 29%, compared to nonsmokers. Because limbs develop very early in pregnancy, the effect may occur even before a woman knows she is pregnant. “Although the overall risk of having these defects is rather small, the increase in risk posed by tobacco exposure has the potential to affect thousands of children,” says study leader Benjamin Chang, MD, pediatric plastic and reconstructive surgeon at The Children’s Hospital of Philadelphia. “Health professionals should increase their efforts to remind women of the dangers of smoking.”

Most States Don’t Make the Grade in American Lung Association Report Card

The American Lung Association has released its annual State of Tobacco Control: 2005 report, grading all 50 states, the District of Columbia, and Puerto Rico on their tobacco control policies with 32 of the graded areas receiving Fs and only eight receiving As. Among the A-ranking areas were California, Delaware, Maine, Massachusetts, New York, Rhode Island, Vermont, and Washington. Those that flunked were Alabama, Alaska, Arizona, Arkansas, Colorado, District of Columbia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, Ohio, Pennsylvania, Puerto Rico, South Carolina, Tennessee, Texas, Virginia, West Virginia, Wisconsin, and Wyoming. Throughout 2006, the association is issuing a challenge to lawmakers and community leaders to make their community free of secondhand smoke.

ICS Most Effective for Persistent Asthma in Children

While both inhaled corticosteroids (ICS) and leukotriene receptor antagonists (LTRA) have been proven to help control mild-to-moderate persistent asthma in school-age children, a new study shows ICS may be the more effective treatment. The study, “Response Profiles to Fluticasone and Montelukast in Mild-to-Moderate Persistent Childhood Asthma,” is featured in the January 2006 issue of the Journal of Allergy & Clinical Immunology.

Researchers found both fluticasone and montelukast led to significant improvements in many measures of asthma control. However, similar to earlier research, they found strong evidence of greater mean improvements after 8 weeks of therapy with an ICS compared with a LTRA across many other outcomes. Patients taking ICS experienced more asthma control days (ACD) in which they had no daytime or nighttime asthma symptoms, along with better pulmonary responses and inflammatory biomarkers. As a comparison, 29.3% of participants had at least one more ACD per week during treatment with fluticasone than during treatment with montelukast (12.2 %).

Avian Flu Transmission to Humans May Be Higher Than Thought

A new study suggests that there is an association between direct contact with dead or sick poultry and flu-like illness in humans and that the transmission is probably more common than expected, according to a new study in the January 9 issue of Archives of Internal Medicine. Anna Thorson, MD, PhD, from the Karolinska Institutet, Stockholm, Sweden, and colleagues analyzed data from household interviews conducted in FilaBavi, a Vietnamese demographic surveillance site in Bavi district, northwest Vietnam, with confirmed outbreaks of highly pathogenic avian influenza (HPAI) in poultry, subtype H5N1. In this study, the researchers found “a total of 8,149 individuals (17.9%) reported flu-like illness, 38,373 persons (84.4%) lived in households keeping poultry, and 11,755 (25.9%) resided in households reporting sick or dead poultry.” “Our results from a large epidemiological population-based study in an area with an ongoing epidemic of HPAI in poultry are consistent with a higher incidence of HPAI among humans than has been recognized previously. The results suggest that the symptoms most often are relatively mild and that close contact is needed for transmission to humans,” the authors conclude.