This article is more than 5 years old. Information may no longer be current.

Top 7 updates in pulmonology from 2014

Topics such as esophageal diseases, pancreatic disease, colorectal cancer, inflammatory bowel disease, and liver disease were covered in the 7 studies selected as the most important and relevant updates from 2014 in the field of pulmonary medicine.

“Key studies were identified from ACP Journal Club and ACP Journal Wise and were some of the most frequently accessed and highest-ranked articles in 2014,” update author Jess Mandel, MD, wrote.

The selected studies were excerpted in the Annals of Internal Medicine as part of its Summaries of the Year’s Most Important Studies Pertaining to the Practice of Internal Medicine. This special issue of the journal, which is the flagship publication of the American College of Physicians (ACP), also features summaries of key medical studies in various other specialties. The issue was timed to coincide with the 100th annual ACP Internal Medicine Meeting here.

The following are the top 7 updates in pulmonary medicine published in 2014.

1. A new therapeutic approach to idiopathic pulmonary fibrosis appears to be effective.

In this summary of three randomized trials, researchers found that an idiopathic pulmonary fibrosis treatment regimen consisting of nintedanib (Ofev, Boehringer Ingelheim) or pirfenidone (Esbriet, Genentech) early in the course of disease may slow the rate of disease progression.

2. In patients with eosinophilic asthma, mepolizumab may yield improved disease control.

This summary of two randomized, placebo-controlled trials reported that the use of monoclonal antibody therapy (mepolizumab, GlaxoSmithKline) may significantly benefit some patients with severe, treatment-resistant asthma.

3. Patients with well-controlled COPD can be safely taken off inhaled glucocorticoid treatment.
In this study of 2,845 patients with COPD, researchers found that in patients who are stable while receiving a long-acting inhaled beta-agonist, long-acting inhaled muscarinic antagonist, and an inhaled glucocorticoid, discontinuation of inhaled glucocorticoid treatment may be considered.

4. Prophylactic azithromycin appears to be effective in reducing the number of acute COPD events requiring antibiotics and glucocorticoids.
This large randomized trial found that azithromycin may hold promise as a long-term prophylactic treatment in patients with COPD who are not frequently smoking, are over age 65 years and who have lower Global Initiative for Chronic Obstructive Lung Disease scores. The drug may also decrease the number of acute exacerbations requiring antibiotics or glucocorticoids.

5. CT scanning for lung cancer appears to be cost-effective.

In this cost-effectiveness analysis, researchers found that low-dose CT was especially cost-effective for women, patients aged 60 to 90 years, current smokers, and those in the two highest risk quintiles for lung cancer. The average cost was $1,631 per person and added an average of 0.0316 life-years per person.

6. Acute cardiogenic pulmonary edema is consistently detectable through point-of-care ultrasonography.

In this meta-analysis of seven studies, researchers found that vs. chest radiography and natriuretic peptide measurement, point-of-care ultrasonography appears to be effective for diagnosis of acute cardiogenic pulmonary edema in patients with acute cardiogenic pulmonary edema in clinics with moderate to high pretest probabilities.

7. While oseltamivir is moderately beneficial in treating influenza in adults, it is associated with adverse effects.

According to the findings of this meta-analysis, clinicians should weigh the benefits and potential toxicities before prescribing antivirals such as oseltamivir to the general influenza patient population. Study findings showed the drug decreased symptom duration by 16.8 hours, but increased the risk for nausea and vomiting.