Daily ReCAP April 24, 2017

Chronic: Asthma Patients Who Use Inhaled Steroids Have Increased Risk of Pneumonia

Scientists have found a link between the use of inhaled corticosteroids and the increased risk of pneumonia. In a study published in theBritish Journal of Clinical Pharmacology, investigators included 152,412 patients with asthma, of whom 1928 had a pneumonia event during follow-up. The results of the study showed that the current use of inhaled corticosteroids was associated with an 83% increased risk of being hospitalized for pneumonia, and the risk was found to be greatest in patients who received higher doses. In addition, dispensing 500 mcg or more of fluticasone-equivalent per day was associated with a 96% increase. Increased risks were observed with both budesonide and fluticasone. “While the increase in risk of pneumonia with the use of inhaled corticosteroids is well recognized in chronic obstructive pulmonary disease, in asthma patients the evidence has been equivocal,” said senior author Dr Pierre Ernst. “Our study suggests the risk may be present in asthma, although pneumonia in patients with asthma remains unusual and inhaled corticosteroids remain the best therapy available.”

Acute: Symptom Relief Immediate Treatment Goal for Worsening Heart Failure

The primary goal in patients with worsening acute decompensated heart failure (ADHF) should be symptom relief, according to an editorial paper published in theNew England Journal of Medicine. The investigators examined the results of the Trial of Ularitide Efficacy and Safety in Acute Heart Failure (TRUE-AHF), which evaluated the safety and efficacy of ularitide administered quickly after a patient presents with ADHF. The review of the TRUE-AHF trial examined 2 hypotheses: that a single infusion of ularitide would improve early clinical outcomes, and that a rapid treatment approach to exacerbation of heart failure improves long-term survival. “We conclude that ularitide, like its predecessor nesiritide, has limited short-term effects that wane after the discontinuation of treatment, which lessens the likelihood that there is a constructive avenue for further development of natriuretic peptides,” said author Paul J. Hauptman, MD. “It also appears that we do not have a mandate to establish rapid-response teams for patients who present with acute decompensated heart failure.” The authors noted the need for greater consensus on how to define intervention responses and determine which patients have the greatest need for treatment.

Preventive: Recommendations Against Nasal Flu Vaccine Still Warranted, Continued Monitoring Crucial

Considering the recent federal recommendations against the use of the inhaled nasal influenza vaccine, a new analysis concludes the continual surveillance of the efficacy of the live attenuated influenza vaccine (LAIV) and influenza uptake is warranted. In a study published in theAmerican Journal of Preventive Medicine, investigators found that under current conditions only offering the needle-delivered flu vaccine results in 20.9% of children ages 2 to 8 years who get the flu compared with 23.5% if both the needle and LAIV are offered. However, if the efficacy of the LAIV improves and can prevent the flu in more than 63% of patients, then it once again becomes beneficial to offer both forms of the vaccine. In addition, the investigators found that if not offering the needleless vaccine drives down vaccination rates by 18.7% or more, then offering both options is the better recommendation. “The CDC is being appropriately cautious and doing the right thing based on available data,” said lead author Kenneth J. Smith, MD, MS. “However, our study findings indicate that it would take only relatively small changes to tip the scales back in favor of offering the LAIV, so close monitoring is very important.”