Abington Pulmonary & Critical Care

Pediatrics Group Releases Flu Vaccine Recommendations for 2019-20 Season. The American Academy of Pediatrics is back to recommending both the live attenuated and the inactivated influenza vaccines for the upcoming flu season. All vaccines available to pediatric patients will be quadrivalent. Children aged 6 to 35 months can now be given either the 0.25 or the 0.5-mL dose of the inactivated flu vaccine. ... Older children should continue receiving the 0.5-mL dose. A new oral antiviral, baloxavir marboxil, will be available for early treatment of uncomplicated influenza in outpatients aged 12 years and up.

Pediatrics Group Releases Flu Vaccine Recommendations for 2019-20 Season. The American Academy of Pediatrics is back to recommending both the live attenuated and the inactivated influenza vaccines for the upcoming flu season. All vaccines available to pediatric patients will be quadrivalent. Children aged 6 to 35 months can now be given either the 0.25 or the 0.5-mL dose of the inactivated flu vaccine. ... Older children should continue receiving the 0.5-mL dose. A new oral antiviral, baloxavir marboxil, will be available for early treatment of uncomplicated influenza in outpatients aged 12 years and up.

Most Dietary Supplements and Interventions Don't Seem to Improve Cardiovascular, Mortality Outcomes Most nutritional supplements and dietary interventions do not protect against all-cause mortality or cardiovascular disease (CVD), according to a large review in the Annals of Internal Medicine. The analysis included 277 randomized controlled trials of 24 dietary supplements and interventions in nearly 1 million adults. Most of the interventions including multivitamins; vitam...ins A, C, and E; vitamin D alone; reduced saturated fat intake; and the Mediterranean diet showed no effect on mortality or CVD. Here are the only significant findings noted: -All-cause mortality: Reduced salt intake was associated with lower risk in normotensive individuals only. -Cardiovascular mortality: Reduced salt intake was protective in hypertensive patients only. -Myocardial infarction and coronary heart disease: Omega-3 long-chain polyunsaturated fatty acids were associated with reduced risk. -Stroke: Folic acid was protective, whereas calcium plus vitamin D supplements conferred increased risk. Ultimately, the editorialists conclude that for now, "it would be reasonable to hold off on any supplement or diet modification in all guidelines and recommendations."

Generic Advair Diskus Approved The FDA has approved the first generic version of the asthma and chronic obstructive pulmonary disease (COPD) inhaler Advair Diskus (fluticasone propionate and salmeterol inhalation powder). The generic inhaler is approved to treat asthma in patients aged 4 years and older and to manage airflow obstruction and reduce exacerbations associated with COPD.

E-Cigarettes Outperform Nicotine Replacement Therapy for Smoking Cessation Adults who smoke conventional cigarettes are more likely to quit smoking successfully when they use electronic cigarettes rather than nicotine replacement therapy (NRT) as a quit aid, according to a randomized trial in the New England Journal of Medicine. Nearly 900 U.K. adults who were looking to stop smoking were randomized to use e-cigarettes or NRT beginning on their quit date. The e-cigarette grou...p was given a starter pack but could then use the product of their choice, while NRT participants could choose their preferred product. All participants also received at least four weekly sessions of behavioral support. The primary outcome the rate of abstinence at 1 year confirmed by carbon monoxide levels favored the e-cigarette group (18% vs. 9.9% in the NRT group).

25% of Antibiotic Prescriptions Could Be Inappropriate At least a quarter of outpatient antibiotic prescriptions filled in 2016 may have been unnecessary, researchers conclude in The BMJ. 23% of prescriptions were classified as inappropriate, usually for acute bronchitis, acute upper respiratory tract infection, or respiratory symptoms... 36% were potentially appropriate, most frequently for acute sinusitis, acute otitis media, or acute pharyngitis. 13% were considered appropriate, most often for urinary tract infections, streptococcal pharyngitis or tonsillitis, and bacterial pneumonia.

Smokers Are Better Off After They Quit Even if They Gain Weight People who gain weight after quitting smoking have a temporary increase in type 2 diabetes risk, but this is offset by long-lasting reductions in mortality, a New England Journal of Medicine study finds. Researchers examined rates of diabetes and mortality after smoking cessation in three large cohorts of U.S. health professionals. During roughly 20 years' follow-up, participants who recently quit smoking were 22...% more likely than current smokers to develop diabetes, with the risk peaking 57 years after quitting and then decreasing thereafter. The increased risk, however, was limited to those who gained over 5 kg after quitting. In terms of mortality, quitting smoking showed a consistent benefit, regardless of weight gain. Even quitters who gained over 10 kg had a 67% reduction in cardiovascular mortality and a 50% reduction in overall mortality, relative to current smokers. The researchers emphasize that even though quitters who gained weight saw a net benefit, "preventing excessive weight gain may maximize the health benefits of smoking cessation through reducing the short-term risk of diabetes and further lowering the long-term risk of death."

FDA Approves Valve for Patients with Severe Emphysema The FDA has cleared a new valve to help patients with severe emphysema breathe. The Zephyr Endobronchial Valve, which is about the size of a pencil eraser, is placed via flexible bronchoscope in the damaged part of the lung airway. When patients inhale, the valves close and restrict airflow into the diseased portion of the lung. When they exhale, the valves open to ease pressure.... In a trial of 200 patients with severe emphysema, 48% of those who received the valves plus medical management had at least a 15% improvement in pulmonary function scores at 1 year, compared with 17% of those who only received medical management. Adverse events included air leak, chest pain, coughing up blood, pneumonia, shortness of breath, worsening of emphysema, and death.

Safety of LABAs in Asthma Confirmed in Combined Analysis The safety of long-acting 2 agonists (LABAs) as combination therapy for asthma has received further reassurance by the publication of a combined analysis of separate FDA-mandated trials in the New England Journal of Medicine. (The drugs' labels featured a boxed warning for over a decade, which the FDA removed in 2017.) LABA manufacturers separately conducted safety trials, which they agreed to harmonize to enable a com...bined analysis by an independent oversight committee. The trials encompassed a total of some 36,000 patients with asthma. Patients underwent randomization either to treatment with a LABA plus an inhaled glucocorticoid, or with the glucocorticoid alone. In the noninferiority trials, the rate of asthma-related intubation or death (the composite primary outcome) did not differ significantly between the two regimens. The rate of asthma exacerbations, however, was modestly lower on combination therapy (9.8% vs. 11.7%). Separately, FDA officials present the data behind their decision to remove the boxed warning.

In Major Surgical Procedures, Older Surgeons Do Slightly Better Older surgeons have a slight, but measurable advantage in operative mortality rates over younger colleagues, a study in The BMJ finds. Researchers examined outcomes in some 900,000 Medicare patients who had undergone a major nonelective surgery between 2011 and 2014. They found a slight, but significant downward trend in perioperative mortality with the increasing age of the surgeon. For instance, the adjusted mo...rtality rate with surgeons under age 40 was 6.6%, versus 6.3% with surgeons aged 60 and over. There was no difference in the trend when the surgeons' gender was taken into account. Female surgeons between 50 and 59 had the lowest operative mortality rates, however. The authors conclude that younger surgeons might benefit from "more oversight and supervision" after residency. They also observe that "patients undergoing surgery receive high quality care irrespective of the sex of the surgeon."

Patients Warned About Fraudulent Flu Remedies Given this season's influenza toll, your patients may be particularly tempted by over-the-counter products claiming to prevent or cure the flu. In a news release on Friday, the FDA reiterated that no OTC products are approved for such uses and listed "telltale signs to look for when trying to spot flu products that may be fraudulent." Have a look at the link below.

Getting Recommended Vaccines During Pregnancy Doesn't Lead to Harm in Infants Getting the recommended vaccines during pregnancy is not associated with increased risk for infant morbidity or mortality in the first 6 months of life, according to an observational study in Pediatrics. The CDC currently recommends that pregnant women be vaccinated against influenza and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap). Using a vaccine safety database, U.S. ...researchers matched roughly 25,000 live, singleton births who were hospitalized during their first 6 months of life to infants who weren't hospitalized. Over 150 infants who died were also matched to controls. After multivariable adjustment, maternal receipt of either vaccine was not associated with infant hospitalization or mortality. The likelihood of maternal Tdap vaccination in pregnancy was reduced for infants with respiratory-related hospitalizations (odds ratio, 0.79), but only 3% of infants hospitalized for respiratory illness had a recorded diagnosis of pertussis. The authors conclude: "These findings support the safety of current recommendations for influenza and Tdap vaccination during pregnancy.

FDA Removes Boxed Warning from Inhaled Corticosteroids Plus Long-Acting Beta Agonists. The FDA is removing the boxed warning from drugs containing both an inhaled corticosteroid and a long-acting beta agonist after studies found that this combination was not associated with increased risk for asthma-related death. Four trials among over 40,000 patients with asthma found that a LABA plus ICS in fixed-dose combination did not pose a greater risk for asthma-related adverse event...s, including hospitalization, intubation, or mortality, compared with ICS monotherapy. Combination therapy was also more effective than monotherapy for reducing asthma exacerbations. However, LABAs used alone remain associated with increased asthma-related mortality, so single-ingredient LABA drugs will continue to carry the boxed warning noting this risk.

Two OTC Remedies No Help for Sore Throat Neither xylitol chewing gum nor probiotic capsules appear to relieve symptoms of pharyngitis, according to a study in the Canadian Medical Association Journal. Researchers first randomized 1000 patients aged 3 years and up with pharyngitis to one of three gum options (xylitol gum [Wrigley Orbit], sorbitol gum [Wrigley Extra], or no gum). Patients were told to chew five sticks a day for 3 months. Patients were also randomized to receive... daily probiotic (lactobacilli and bifidobacteria) or placebo capsules for 3 months. For the primary outcome sore throat severity and trouble swallowing on days 2 to 5 there were no significant differences among the interventions, suggesting they had no effect. The authors note that they had primary outcome data available for 74% of patients. The authors conclude: "There is no reason for clinicians to advise patients to use either of these treatments for the symptomatic management of pharyngitis."