Antibiotic-resistance and the need to revise lung treatment strategies

The proliferation of antibiotic-resistant bacteria is feared to be an event that might plague the 21st century if the problem is not addressed now. Desmond Heng Wen Chien of the A-Star Institute of Chemical and Engineering Sciences forewarns that antimicrobial resistance could be the leading cause of death by 2050 if proliferation cannot be stemmed.

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These superbugs have increased the mortality rate of respiratory infections to as high as 80 percent in some clinics. A study of antibiotic resistance in Pseudomonas aeruginosa, a type of bacteria that causes lung infection, found that the bacteria has enhanced fitness and can survive in a host even with an onslaught of various antibiotics.

Awareness among the public is key to mitigate the indiscriminate consumption of antibiotics. Physicians should communicate to their patients that for non-fatal respiratory infections such as the common cold and cough, the illness often resolves over time without medication. Doctors recommend taking vaccines for common respiratory illnesses to defend against infections and their subsequent need for treatment.

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Dr. Lisa Marie Cannon is an internist based in New Jersey specializing in pulmonology, sleep medicine, and critical care. For more blogs on respiratory health, follow this link.

Asthma-COPD overlap syndrome: The result of lung airway remodeling

Asthma-COPD overlap syndrome or ACOS accounts for up to a quarter of all obstructive airway diseases. Patients afflicted with it usually exhibit worse symptoms when compared to patients with asthma or chronic obstructive pulmonary disease (COPD) alone. ACOS is not well recognized because asthma and COPD have almost similar manifestations. Most patients suffering from this disease are smokers who exhibit persistent expiratory airflow obstruction despite treatment.

Asthma and COPD are widespread respiratory disorders that cost billions of dollars in healthcare-related expenses every year. Both diseases, when not properly diagnosed and treated, may escalate to worse conditions and even death.

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ACOS is characterized by a phenomenon called “remodeling.” This consists of any or a combination of the following:

• Mucosal edema, mucus hypersecretion, and formation of mucus plugs.
• Hypertrophy and hyperplasia of the airway smooth muscle 
• Increased wall thickness of the respiratory tract

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Awareness of ACOS is growing and approaches for how to best manage this condition are being assessed to achieve the best possible results. There is a consensus among physicians that patients with features of both asthma and COPD experience frequent exacerbations, suffer from rapid decline in lung function, have poor quality of life, have high mortality, and on rare occasions, incur chronic inflammation even outside the respiratory system.

Dr. Lisa Marie Cannon is a recognized internist, specializing in pulmonary medicine. Follow this Twitter account for more medical news and updates.

REPOST: Healthier lungs in California kids after pollution controls

A study conducted in California found better lung function among kids as the state's air quality improved.  This Reuters article provides the details.

(Reuters Health) - Doctors have long predicted that less air pollution will produce healthier lungs. Now a first-of-its-kind study of 2,120 children in southern California has documented dramatically better lung function growth as air quality has improved.

       

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Over a 13-year period, the proportion of children with poor lung capacity and lung health fell by half as levels of nitrogen dioxide and particulate matter dropped. The gains were seen both in youngsters who had asthma and in those who did not.

“It certainly supports the efforts that have been made over 40 years to improve air quality,” chief author Dr. James Gauderman of the Department of Preventive Medicine at the University of Southern California in Los Angeles told Reuters Health. “We would expect improvements in other urban centers to produce similar improvements in children’s health.”

The study, published in the New England Journal of Medicine, complements research showing that childhood lung function deteriorates and the risk of asthma rises as pollution levels rise.

"This is an association study, so there's always a question of cause and effect. Maybe these people got healthier on their own, ate better diets. You can never say it's an absolute proof," said Dr. Norman H. Edelman, senior consultant for scientific affairs at the American Lung Association.

        

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"But it's not a standalone study. It's based on older studies that show an association between the degree of air pollution and lung function in kids. This turns around and looks at improvement," he told Reuters Health.

Gauderman and his colleagues examined the long-term effects in children by studying three groups during three time periods between 1994 and 2011. Typically, the children entered the study around age 11 and were followed for four years, a period when the lungs are developing rapidly. All lived in the Los Angeles area, a region of the U.S. known for air pollution problems, which have been abating as a result of strict state controls.

“We looked at the proportion of children whose lung function was below 80 percent of normal. That’s a cutoff a physician will often use to flag a person for a possible issue with their lungs,” Gauderman said. While 7.9 percent of children fell into that category in 1998, the proportion had dropped to 3.6 percent by 2011.

“We certainly suspected that improving air quality would improve children’s health,” Gauderman said. “We were surprised by the magnitude of the effect that we’ve seen.”

"What's news about this is the large magnitude of the effect, from 8 percent down to 4 percent," said Edelman, who was not connected to research. "Asthma is present in 10 percent of the population and that's a major health problem. If a percentage of those kids is going to have worse asthma because the air pollution has limited their lung growth, that's a big deal."

During the study years, the air improved “dramatically,” Gauderman’s team writes in their report. For example, in 1994-1997, each cubic meter of air in one of the most-polluted communities, Mira Loma, had 31.5 micrograms of small particles called PM2.5 that penetrate deep into the lungs. By 2007-2010, Mira Loma averaged 17.8 micrograms of PM2.5 per cubic meter of air, a 43 percent decline. All five study sites had significant drops in particle pollution and nitrogen dioxide, they note.

Overall, average lung capacity increased by 91.4 milliliters for every decrease of 14.1 parts per billion in nitrogen dioxide. It rose by 65.5 ml for each decrease of 8.7 micrograms per cubic meter of particle pollution. Significant changes were not linked to ozone levels, but levels of that pollutant have not declined as dramatically over time.

       

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“There were significant effects on lung-function growth in both boys and girls, although the magnitude of the air-pollution effect was significantly larger in boys than in girls,” the researchers conclude.

“We found no significant association between growth in height and change in pollution during the study period, which indicates that our findings on lung-function growth are probably not the result of a secular trend in general development,” they write.

California has stricter pollution controls than the U.S. as a whole, but Edelman said even the federal clean air act has cleaned up a lot of pollution "and this study is part of that. We're making progress. There's still a long way to go. We still have much more unacceptable effects of air pollution than we should have."

Dr. Lisa Marie Cannon is a board certified physician who specializes in pulmonary care.  Visit this Facebook page for more access to resources on related topics.