Ventilation mask leakage may contaminate hospital setting

American College of Chest PhysiciansOct 6 2009

New research shows that certain noninvasive positive pressure ventilation (NPPV) masks may leak exhaled air up to a distance of 1 m from patients receiving treatments. This finding raises concerns about the potential spread of highly contagious respiratory illness within the hospital setting. Using a patient simulator that mimicked a patient with mild lung injury, researchers from Hong Kong measured the exhaled air leakage from two different face masks. Inspiratory pressure (IPAP) was gradually increased while expiratory pressure remained the same. Results showed that there was substantial exposure to exhaled air within a 1 m region of the patient receiving treatment. In addition, results showed that higher IPAP resulted in higher contamination. Researchers suggest that health-care workers take adequate precautions when providing NPPV support to patients with highly contagious or unknown respiratory conditions. This study is published in the October issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.

UNCONTROLLED ASTHMA PREVALENT AMONG MINORITY CHILDREN

African-American and Hispanic children have a high incidence of uncontrolled asthma, compared with Caucasian children with asthma. Using data from the National Asthma Survey, researchers from the Centers for Disease Control and Prevention assessed symptom control, medication use, and health-care utilization among 1,485 Caucasian (55 percent), African-American (20 percent) and Hispanic (25 percent) children with current asthma who reside in Alabama, California, Illinois, or Texas. The analysis showed that, compared with Caucasian children, African-American and Hispanic children had more indicators of poorly controlled asthma, including increased emergency health-care utilization, more daily rescue medication use, and less use of inhaled corticosteroids. The article is published in the October issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.

LABAs/ICS COMBINATION THERAPY MAY DO MORE HARM THAN GOOD

Current guidelines recommend the use of inhaled corticosteroids (ICS) in combination with long-acting beta agonists (LABAs) to reduce the frequency of exacerbations in symptomatic patients with severe to very severe chronic obstructive pulmonary disease (COPD). However, new research shows that this combination therapy may not provide significant benefits for patients and may cause adverse events. Researchers from Spain, Chile, and Uruguay reviewed 18 randomized controlled trials with 12,446 participants where the primary outcomes were COPD exacerbations and mortality. The analysis showed that therapy with LABAs/ICS did not decrease severe exacerbation or all-cause or respiratory mortality; however, moderate exacerbations were significantly reduced. Furthermore, the combination therapy was associated with an increased risk of pneumonia. This article is published in the October issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.