American Thoracic Society Journal news tips for December (second issue)

December 12, 2002

INHALED CORTICOSTEROIDS RAISE RISK OF HIP FRACTURE

In a large study of older persons, investigators have found that recent use of inhaled corticosteroids was associated with a dose-related increase in hip fracture. British researchers studied 16,341 cases of hip fracture found in the United Kingdom General Practice Research Database. Control subjects numbered 29,889 persons. Seventy-nine percent of the participants were female, and had a median age of 79. In the U.K., about 1 in 10 persons over 65 are given a prescription for an inhaled corticosteroid to manage either asthma or chronic obstructive pulmonary disease (COPD). According to the authors, a small increase in the risk of hip fracture can have a considerable public health effect. In previously published results from the Lung Health Study, use of 1,200 micrograms per day of inhaled corticosteroid caused a reduction in the bone mineral density in the lower lumbar spine and femur. In this study, the researchers found that the risk of hip fracture associated with exposure to inhaled corticosteroid had an odds ratio of 1.26. They said that the strategy for patients with either asthma or COPD was to take no higher dose of inhaled corticosteroids than was needed to control their airflow obstruction. This research appears in the second issue for December 2002 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.

HIGH-FREQUENCY OSCILLATION VENTILATION BETTER FOR VERY LOW BIRTH WEIGHT BABIES

Initial treatment with high-frequency oscillation ventilation in very low birth weight babies who develop chronic lung disease can lead to less airway damage and better outcome at 1 year of life. Dutch researchers measured lung function in very low birth weight babies (less than 3 pounds) at 12 months corrected age. (Most of the babies had a gestational age at birth of almost 27 weeks, with 26 of them still "oxygen dependent" at 36 weeks.) Chronic lung disease is a common result associated with oxygen therapy in premature, low birth weight infants. When the appropriate equipment was available, high-frequency oscillation ventilation was started first in the youngest and smallest infants. The investigators found that the mean forced expiratory flow rate was significantly better at 1 year of life in the 15 babies initially treated with high-frequency oscillation ventilation. The research appears in the second issue for December 2002 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.

LARGE PLEURAL EFFUSION FOLLOWS CORONARY ARTERY BYPASS SURGERY

More than 50 percent of coronary artery bypass surgery patients in a large study had a pleural effusion when checked approximately 1 month after surgery. At 28 days, close to 10 percent of these patients had a large pleural effusion that occupied more than 25 percent of one-half of their chest. The investigators studied 398 patients. They noted that most pleural effusions were small, left-sided, and regressed spontaneously. However, 40 patients had an effusion that was much larger, and disappeared gradually over the following year. Pleural effusion involves the abnormal accumulation of fluid in the pleural space of the chest. (The pleura are thin, transparent membranes that cover the lung and inside of the chest wall.) According to the authors, the large pleural effusions detected in this study produced severe breathlessness (dyspnea), but neither chest pain nor fever. The results of this study are published in the second issue for December 2002 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.
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For the complete text of these articles, please see the American Thoracic Society Online Web Site at http://www.atsjournals.org. For either contact information or to request a complimentary journalist subscription to ATS journals online, or if you would like to add your name to the Society's twice monthly journal news mailing list (please select either postal or electronic delivery), contact Cathy Carlomagno at 212-315-6442, or by e-mail at ccarlomagno@thoracic.org.

American Thoracic Society

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