Steroids in acute COPD exacerbations

COPD exacerbations are incredibly common, managed under respiratory and general medical units for the most part. The duration of higher dose steroids vary however – some give just a few days, others up to two weeks. The REDUCE trial from JAMA this month proves the optimal duration, comparing 5 with 14 days.

Essentially, just over 311 patients were looked at with both intention to treat and per protocol analysis. There wasn’t any difference etween time to re-exacerbation or mortality, meaning that you can get away with a shorter course of steroid. Presumably this would lead to less adverse reactions – this trial didn’t see any difference in hyperglycaemia or hypertension however.

So, five days seems like the way to go. Keep this in mind for next time – read the article here. And of course, don’t forget to re-iterate the importance of smoking cessation.

 

source | JAMA 

image | Pulmonary Pathology

review: infective endocarditis

 

A new clinical review article over at the NEJM, summarising medical treatment and surgical indications. As always, a good read.

Check it out here.

 

 

 

source | New England Journal of Medicine

image | ephemeral scraps

Getting off the ventilator

It’s often all lights and sirens when people are being intubated in an emergency situation, but once the intensive care unit has taken over and got things under control, you need to make a decision to get patients off the breather.

guideline | cholangiocarcinoma

 

Left of the image looks OK, the right not so much – it’s not the diagnosis, but the treatment that can be hard to manage.

Smoking doubles your mortality and cuts ten years off your life

Pretty dramatic headline, I know, but this is what has come out of a population based prospective study from Japan, published in this month’s BMJ. 

review | bacterial meningitis

The headache, photophobia, and neck stiffness combination strikes fear into any doctor working in emergency departments around the world, and we all know that the clock is ticking. Lumbar puncture, antibiotics and steroids all need to occur quickly – but what’s new in the world of bacterial meningitis?

The effects of statin on cancer

In late 2010, we mentioned an article from Gut talking about statins reducing the risk of colorectal cancer, albeit by just 8%. Now there’s a new article from the New England Journal of Medicine suggesting reduced cancer related mortality overall in those on statin therapy.