Researchers at the University of Texas Medical School at Houston have discovered that toddlers with sleep apnea experience more respiratory disturbances when they sleep on their backs than in other positions. Their findings, which contradict earlier studies on the subject, were published in the November 2005 issue of Archives of Otolaryngology–Head & Neck Surgery.

“Our study indicates that supine sleep does correlate with an increase in RDI [respiratory disturbance index] as well as with obstructive sleep apneas in patients younger than 4,” says Kevin D. Pereira, MD, professor of otolaryngology at the UT Medical School and chief pediatric otolaryngologist at Memorial Hermann Children’s Hospital. “This finding is in contrast to previous studies that have demonstrated no correlation between sleep position and obstructive sleep apnea in children.”

Pereira also notes that the study was not conducted on infants, so its findings should not be confused with the practice of having infants sleep on their sides or back to help avoid sudden infant death syndrome.

Targeted Treatment for Asthma Sufferers

The bronchial tubes of a patient with severe asthma can become scarred due to repeated episodes of allergic inflammation in the airways. The scarring results in blocked airways, excessive production of mucus, and shortness of breath.

Researchers at University of California, San Diego (UCSD) School of Medicine have discovered that when a single gene—IKK beta—is selectively inactivated in the membrane-lining cells of the bronchial tubes of mice, such scarring, mucus production, and airway inflammation are significantly reduced.

David H. Broide, MB, ChB, professor in UCSD’s Department of Medicine, and Michael Karin, PhD, professor in UCSD’s Department of Pharmacology and the Laboratory of Gene Regulation and Signal Transduction, published their findings in the December 6, 2005, issue of the Proceedings of the National Academy of Sciences.

“This finding is significant because it suggests that if we can produce a drug that inhibits IKK beta–for example, a drug that is inhaled to target only the patient’s bronchial tubes and not their immune cells–then the scarring, inflammation, and mucus production in asthma could be significantly reduced,” says Broide.


 AARC Congress Delivers Winning Platform
Respiratory therapists, clinicians, and other attendees at the American Association for Respiratory Care’s 51st International Respiratory Congress packed the exhibit hall and took in information on the latest respiratory care technologies and issues facing the industry. Sessions included presentations varying from home care to sleep to the future of respiratory therapy. “I think there were numerous excellent lectures and symposia,” says Joe Lewarski, BS, RRT, FAARC, vice president of clinical and governmental affairs, Inogen, Goleta, Calif. “Depending on your specialty area and areas of interest, there was much to be found. As a home care- focused clinician, I particularly enjoyed the sessions on the evidence for home respiratory care, including the evidence for long-term oxygen therapy, oxygen-conserving devices, and sleep therapy. In addition, the sessions on the business of home care were also interesting and practical, especially in light of the many issues facing home RTs today.”

 AARC 2005 president John D. Hiser, MEd, RRT, FAARC, (right) installs Michael W. Runge, RRT (left), as 2006 AARC president.

In the exhibit hall, manufacturers took advantage of the opportunity to showcase their products. “This is a chance to get in front of the RTs who handle and use our products every day and the doctors and clinicians who direct the RTs in their daily work,” says Kelly Rudolph, marketing manager, Hans Rudolph Inc, Kansas City, Mo. “The show has been very good so far. I don’t think I stopped talking all day about new and old products.”

The congress also featured the always-competitive Sputum Bowl, award presentations, and the installation of the 2006 AARC president Michael W. Runge, RRT.

American Heart Association Updates Emergency Care Guidelines
New emergency care guidelines include dramatic changes to cardiopulmonary resuscitation (CPR) and emphasis on chest compressions, according to authors of the 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. The guidelines were published online in Circulation: Journal of the American Heart Association. They provide recommendations for how lay rescuers and emergency health care providers should resuscitate victims of cardiovascular emergencies. Topics include CPR, the use of automated external defibrillators (AEDs), and recommendations for advanced cardiovascular life support (ACLS) and pediatric advanced life support (PALS).

Moderate to Severe Sleep-Disordered Breathing Can Lead to Stroke
Individuals who experience moderate to severe sleep-disordered breathing are four times more likely to have a stroke during the next 4 years than those who do not suffer from the problem. These findings were reported in the December 1, 2005, issue of the American Journal of Respiratory and Critical Care Medicine. “Our longitudinal analysis provides the first prospective evidence that sleep-disordered breathing after adjustment for age and sex is related to significantly increased odds of suffering a stroke over the next 4 years,” says T. Douglas Bradley, MD, of the Toronto General Hospital/University Health Network in Toronto, Canada. “Although our analysis cannot shed light on the pathway by which sleep-disordered breathing affects stroke risk, these novel findings add justification to considering the problem as a condition that either precedes or may contribute to the development of stroke.”

Endotoxins in House Dust Pose Significant Risk for Asthma
Exposure to household endotoxin levels poses a significant risk factor for asthma, according to a representative nationwide sampling of house dust. The study appears in the December 1, 2005, issue of the American Journal of Respiratory and Critical Care Medicine. “This study clearly demonstrates significant relationships between household endotoxin and diagnosed asthma, recent asthma symptoms, current use of asthma medications, and wheezing,” says Peter S. Thorne, MS, PhD, of the Environmental Health Sciences Research Center at the University of Iowa in Iowa City. “No effect was observed of allergy status on the relationship between endotoxin and asthma outcomes. This suggests that current endotoxin exposure may have little impact on allergy status and that airway inflammation is the most significant effect of endotoxin exposure in a cross-section of the population.” The authors found the strongest relationship between asthma, asthma medications, and wheezing came from endotoxin levels in bedroom floor and bedding dust. However, the effects were observed only in adults and not in children. The investigators also noted that endotoxin concentrations were highest in kitchen and living room floor dust and lowest for bedding (including the mattress and pillow).

Pneumonia Hospitalization Rates on the Rise for Older Adults
Hospitalization rates for pneumonia have increased substantially for US adults 65 to 84 years of age, according to a study in the December 7, 2005, issue of JAMA. The researchers found that hospitalization rates for pneumonia increased by 20% from 1988-1990 to 2000-2002 for patients aged 65 to 74 years and for patients aged 75 to 84 years. “Because the number of individuals at highest risk for pneumonia, those aged 85 years or older, will continue to increase in the United States and behavioral changes may be difficult to sustain, additional strategies, such as more effective vaccines for older individuals and new vaccines for common pathogens without a currently licensed vaccine … will likely be necessary,” the authors write.

Omega-3 Fatty Acids Can Improve Lung Function
A diet rich in omega-3 fatty acids, such as those found in fish, canola oil, and walnuts, can have anti-inflammatory effects and improve the exercise capacity for patients with chronic obstructive pulmonary disease (COPD). For 2 years, Japanese researchers followed 32 patients with COPD on an omega-3 fatty acid-rich diet (treatment group) and 32 patients with COPD on a non-omega-3 fatty acid-rich diet (nontreatment group). Every 3 months, dyspnea scores, levels of inflammatory mediators, and exercise capacity were recorded. Overall, results showed that dyspnea scores and exercise capacity significantly improved, and inflammatory mediators significantly decreased for patients in the treatment group, while there was no significant change in the nontreatment group. Researchers suggest that nutritional support with an omega-3 fatty acid-rich diet is a safe and practical method for treating COPD. The study appears in the December issue of CHEST.

Avian Influenza Precautions Available
An editorial in the December issue of Mayo Clinic Proceedings offers suggestions to physicians that could help answer questions presented by patients who may be feeling anxious about the “bird flu.” “If an avian flu pandemic were to occur this winter, we would not be adequately prepared to deal with it,” says Priya Sampathkumar, MD, Mayo Clinic Division of Infectious Diseases. However, the coauthors, Sampathkumar and Dennis Maki, MD, University of Wisconsin Medical School?s Section of Infectious Diseases, say that quarantining methods, antiviral medications, and other measures could help contain an outbreak at its earliest stages, if health professionals can ensure the following:

• Very early identification of cases and efficient ongoing surveillance for new cases.

• Sufficient stockpiles of antivirals, with the capacity for rapid delivery of antivirals to the target groups.

• Rapid institution and enforcement of quarantine measures and a high level of compliance with these measures among the target population.

• International cooperation with the strategies above, including travel restrictions and, perhaps most important, sharing of national antiviral stockpiles.

The coauthors say that even if these strategies do not curtail a pandemic, they might buy time to better prepare by increasing production of vaccine and antivirals, both of which could save millions of lives.

These suggestions to practicing physicians may help in answering patients’ questions:

• Will getting a flu shot protect individuals from avian influenza? The annual flu shot does not protect against the new avian flu strain that originated in Asia. But getting the flu shot is a good idea to protect against seasonal influenza.

•What can patients do to protect themselves against influenza–especially if they travel frequently? Travelers to countries where avian influenza is endemic in bird populations should avoid contact with poultry or with surfaces that may have been contaminated by poultry or their feces or secretions. Eating poultry products is safe so long as they are fully cooked. Practice frequent hand washing.

• Do antivirals work? Should patients have their own supplies of antivirals? The antiviral drugs–oseltamivir (Tamiflu) and zanamivir (Relenza)–have shown good activity against most H5N1 strains. However, giving prescriptions for these drugs to individual patients in advance of a pandemic may divert the limited supplies of these medications from people who need them.

Pulmonary Fibrosis Linked to Genetic Susceptibility and Smoking
Because genetic susceptibility plays a significant role in the development of pulmonary fibrosis, physicians should maintain a high degree of suspicion when examining any patient who has a family history of this fatal disease, especially smokers, according to a new study published in the November 1, 2005, American Journal of Respiratory and Critical Care Medicine.

“Our findings suggest that familial interstitial pneumonia may be caused by an interaction between a specific environmental exposure and a gene or genes that predisposes to the development of several subtypes of interstitial pneumonia,” says Mark P. Steele, MD, of the Duke University Medical Center, Durham, NC. “Subjects with definite familial interstitial pneumonia died at a younger age, had higher mortality, and had a shorter time to death from their age at diagnosis.” The authors also noted that cigarette smoking may lead to the development of pulmonary fibrosis in individuals who are genetically prone to the problem, since lung injury can interact with genetic susceptibility and substantially contribute to illness.
Although the investigators strongly associated smoking with the development of the disease, they conclude that genetic susceptibility plays a more significant etiologic role, even among smokers.

Patients Report Better Asthma Control When Seeing an Allergist
Compared to patients receiving care from primary care physicians, asthma patients who are under the care of an allergist report fewer asthma control problems and less severe symptoms, according to new research in the December 2005 Journal of Allergy & Clinical Immunology.

Patients seeing an allergist also reported significantly higher scores for asthma-specific quality of life and for overall general health; and significantly better understanding of how to manage their asthma and greater overall satisfaction with their care.

Bleaching Agents: Risk Factor For Respiratory Disease
Exposure to persulphate salts in hair bleaching agents may lead to occupational asthma and rhinitis in hair stylists, shows a new study. Italian researchers performed allergy tests, lung function tests, and specific inhalation challenge (SIC) on 47 hair stylists (mean age 25) suspected of having occupational asthma. Average overall duration of exposure to persulphate salts was 7 years. Results showed that 51.1% of patients were diagnosed with occupational asthma; 87.5% of the cases were attributed to persulphate salts, 8.3% to permanent hair dyes, and 4.2% to latex. In addition, 54.2% of patients were diagnosed with occupational rhinitis; 84.6% of the cases were due to persulphate salts. Thirty-six percent of patients were diagnosed with occupational dermatitis. Subjects with occupational asthma attributed to persulphate salts had a long period of exposure to bleaching agents and a long latent period between the start of exposure and the onset of symptoms. The study appears in the November issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.