Home CHEST Thought Leaders Hot in CHEST March 2018

Hot in Journal CHEST March 2018

By: Dr. Deep Ramachandran

Deep Ramachandran 2017Each month, we ask Drs. Chris Carroll and Deep Ramachandran, Social Media Co-Editors of CHEST, to weigh in on the hot topics in CHEST. It's March, so let's hear from Dr. Ramachandran as he outlines his highlights. After reviewing the issue, be sure to share your hot list on our Facebook wall, tweet with the hashtag #journalCHEST, or discuss in the CHEST LinkedIn group.


Study Shows That Bariatric Surgery Reduced COPD Exacerbations by More Than Half

I often tell my patients with COPD that quitting smoking can have a greater effect on their respiratory health than any inhaler that I could prescribe them. Should I now also extend that advice to include weight loss for obese patients with COPD? In this journal CHEST® study, researchers used registry data to look at COPD exacerbations for patients both before and after bariatric surgery. In the year before bariatric surgery, risk of COPD exacerbations was 31%. Looking at the rate of COPD exacerbations during the year after bariatric surgery, that rate dropped to 12%, an astounding change.

The accompanying editorial proposes mechanisms explaining why this might be so and postulates whether obesity could be a modifiable risk factor in COPD. While these results are certainly exciting, we look forward to future investigation into whether bariatric surgery, or other weight loss means, could further help reduce risk of COPD exacerbation.

Pneumonia: If You Can’t See It, Does It Still Exist?

The diagnosis of pneumonia requires the radiographic presence of infiltrates on imaging. However, with its greater resolution, CT scanning can often demonstrate infiltrates when none are seen on chest roentgenogram. Do we treat these the same as a regular pneumonia? This study sought to quantify differences between patients with pneumonia as seen on a chest radiograph vs CT scanning. The differences between the two groups appeared to be minor, with procalcitonin levels appearing to be lower in the CT group. Otherwise, it would appear that patients with pneumonia seen only on CT scanning should be managed like other groups.

The accompanying editorial raises the question of what to do with patients who are suspected of pneumonia but have negative chest radiographs. Certainly, exposing them all to CT scanning can’t be the right answer. Perhaps we should err on the side of caution and treat these patients for pneumonia when clinical suspicion is high. Conversely, we should consider CT scanning in this group only if suspicion is low and the presence of an infiltrate would change management.

SIRS: The Mortality Indicator That Won’t Die

It’s been a couple of years now since the new Sepsis-3 guidelines were presented, proposing to replace SIRS criteria with the q-SOFA criteria. Since then, there has been heated debate regarding the criteria proposed in Sepsis-3. I won’t go into that here; but for a nice review, take a look at this recent article “SIRS in the Time of Sepsis-3”. To provide more ammunition to detractors of q-SOFA, this study in CHEST® looked at studies comparing the two criteria as they relate to non-ICU patients. The authors found that SIRS was actually superior to q-SOFA in the diagnosis of sepsis in this group of patients, while q-SOFA proved to be a better predictor of hospital mortality than SIRS. Certainly, there will be additional study to determine where both of these criteria are best used.

Acupuncture vs Nicotine Replacement Therapy

In this randomized trial, researchers recruited patients at seven different hospitals in China, treated them initially for 8 weeks, and then followed them up for an additional 16 weeks. They compared abstinence rates between nicotine replacement, acupuncture, and auricular point pressing. They found that both nicotine replacement and acupuncture provided similar rates of abstinence, with both being better than auricular point pressure. While mechanisms of acupuncture remain uncertain, it appears that this is an intervention that appears to have merit.