So, is this a problem? I’m going to go get a sleep study done. Possibly a CPAP. It’ll be interesting to be an elephant every night. Very sexy, I’m told. But those who I have spoken to who have gotten one seem to say it changed their lives for the better and is totally worth it.

Thoughts?

#pulmonology #sleep #snoring #insomnia #breathing #elephants #pinkelephants #heffalumps #woozles

We're finishing out our @hottopicsneo coverage with a great episode featuring @profitjochen chatting about QI and it's role in neonatal health equity as well as the recap of the hottest pulmonary topics this year!

#nicu #neotwitter #bpd #pulmonology #healthequity

https://buff.ly/4gllthw

WHO Warns of Carbapenem-Resistant Hypervirulent Klebsiella pneumonia

https://jamanetwork.com/journals/jama/fullarticle/2823269

#health #medicine #Klebsiella #InfectiousDiseases #pneumonia #Pulmonology #PulmonaryMedicine

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{Acronym alert - glossary at bottom.} I see more #asthma patients getting bumped from ICS-only monotherapy (and/or SABA-only rescue med) to combo ICS-LABA inhalers. This is spurred by GSK discontinuing brand-name Flovent, and GINA guidelines promoting AIR and MART (aka SMART) strategy, which utilizes a combo inhaler containing formoterol, like Symbicort, Breyna, or Dulera. This is a big change for many people, who're used to using an inhaled #steroid for control and prevention, and inhaled #albuterol for rapid relief. Now they can use one inhaler for both -- which is convenient, and may bring better control.

Explainer "What is SMART Therapy for Asthma?": https://allergyasthmanetwork.org/news/asthma-smart-therapy/

Now I'm also seeing PCPs, pediatricians, and pulmonologists prescribing other combo ICS-LABA inhalers like Advair with a SMART asthma action plan -- even though that's not approved under GINA or NAEPP guidelines. In fact they explicitly warn against this: "Combination ICS with non-formoterol LABA cannot be used as-needed for symptom relief." (GINA main report, p. 69). LABAs like salmeterol (more lipophilic) take much longer to kick in (30+ minutes) to be intended for rapid relief, and have not been studied for rescue use. But they're being prescribed that way anyway, presumably due to availability, insurance coverage, and clinician confusion during a time of flux. Leading to a lot of follow-up conversations.  ​

GINA 2023 main report: https://ginasthma.org/wp-content/uploads/2023/07/GINA-2023-Full-report-23_07_06-WMS.pdf .

NIH NAEPP 2020 Asthma Guidelines: https://www.jacionline.org/article/S0091-6749(20)31404-4/fulltext

Glossary (in no order):

• ICS == inhaled corticosteroid (Flovent, QVAR). Steroids reduce airway inflammation slowly over time.
• SABA == short-acting beta-agonist: a bronchodilator (canonically albuterol) that quickly relieves airway constriction, for a few hours.
• LABA == long-acting beta-agonist (ex: salmeterol, formoterol), relieves airway symptoms for more than a few hours.
• Rescue med, aka "reliever" == a rapid-acting drug to relieve acute symptoms (e.g. albuterol, epinephrine).
• Maintenance therapy == drug you take daily to prevent acute symptoms.
• Monotherapy == managing a disease with just one drug.
• AIR == Anti-Inflammatory Reliever: combo inhaler with a low-dose steroid + a rapid-acting bronchodilator
• MART == Maintenance And Reliever Therapy: treatment with an inhaler that contains both a steroid and a rapid-onset, long-acting beta-agonist (formoterol). Also called SMART (S == "Single-inhaler").
• GINA == Global Initiative on Asthma

#MedMastodon #pulmonology #pediatrics

Please watch Sarah's story & other testimonies from #PHAUK on the journey to diagnosis of #PulmonaryHypertension

During 8 long years of #breathlessness, she faced disbelief from doctors who told her she was "unfit" & "anxious", then a diagnosis of chronic fatigue sd, before a correct PH #diagnosis.

#medicine #MedMastodon #Dyspnea #PCCM #Pulmonology #cardiology

https://youtu.be/6UY__sr2mgk?si=jnPJJyZ__tMK3Pbm

World Health Organization (WHO)
@WHO (I saw this on twitter)

WHO statement on reported clusters of respiratory illness in children in northern China

WHO has made an official request to #China for detailed information on an increase in respiratory illnesses and reported clusters of pneumonia in children.

At a press conference on 13 November 2023, Chinese authorities from the National Health Commission reported an increase in incidence of respiratory diseases in China.

Chinese authorities attributed this increase to the lifting of COVID-19 restrictions and the circulation of known pathogens such as influenza, mycoplasma pneumoniae (a common bacterial infection which typically affects younger children), respiratory syncytial virus (RSV), and SARS-CoV-2 (the virus that causes COVID-19). Authorities stressed the need for enhanced disease surveillance in healthcare facilities and community settings, as well as strengthening the capacity of the health system to manage patients.

On 21 November, media and ProMED reported clusters of undiagnosed pneumonia in children in northern China. It is unclear if these are associated with the overall increase in respiratory infections previously reported by Chinese authorities, or separate events.

On 22 November, WHO requested additional epidemiologic and clinical information, as well as laboratory results from these reported clusters among children, through the International Health Regulations mechanism.

We have also requested further information about recent trends in the circulation of known pathogens including influenza, SARS-CoV-2, RSV and mycoplasma pneumoniae, and the current burden on health care systems.

WHO is also in contact with clinicians and scientists through our existing technical partnerships and networks in China.

Since mid-October, northern China has reported an increase in influenza-like illness compared to the same period in the previous three years. China has systems in place to capture information on trends in influenza, influenza-like illnesses, RSV, and SARS-CoV-2, and reports to platforms such as the Global Influenza Surveillance and Response System.

While WHO seeks this additional information, we recommend that people in China follow measures to reduce the risk of respiratory illness, which include recommended vaccination; keeping distance from people who are ill; staying home when ill; getting tested and medical care as needed; wearing masks as appropriate; ensuring good ventilation; and regular hand-washing.

WHO will continue to provide updates.
World Health Organization (WHO) Western Pacific
5:24 PM EST · Nov 22, 2023

#China
#pneumonia
#epidemiology
#Covid
#RSV
#WorldHealthOrganization
#influenza
#MycoplasmaPneumoniae
#health
#pulmonology