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The top journal papers for October
Asthma inhalers ‘a risk for infection in elderly’
Older people using steroid inhalers for asthma or COPD are at high risk from hard-to-treat bacterial infections, according to new research.
Steroid inhalers increase the risk of lung infections caused by nontuberculous mycobacteria, which are resistant to a number of common antibiotics.
The study included people with COPD or asthma aged 66 and older, and found those patients who used steroid inhalers were around twice as likely to be diagnosed with an infection of this type.
It also found the longer the inhaler had been used, the greater the risk, with fluticasone posing a two-fold risk of infection.
Study lead Professor Sarah Brode, assistant professor of medicine at the University of Toronto, said: ‘Clinicians should carefully consider the potential benefits and harms of steroid inhalers in patients with asthma or COPD, especially those who have had an infection of this type in the past.’
Eur Respir J 2017, online 20 Sep
CFS training course ‘effective’ for children
A training course (the Lightning Process) for children with chronic fatigue syndrome has been shown to be effective in improving physical activity levels and is ‘probably’ cost-effective.
The Lightning Process is a three day course based on osteopathy, life-coaching and neurolinguistics programming. The study found that after six months, physical function was 12.5 points higher on a physical function survey in children following the Lightning Process compared with those on standard care.
Patients had reduced fatigue and anxiety levels after six months compared with standard medical care, as well as less depression and improved school attendance at 12 months.
An economic analysis found the process was more cost-effective than standard care, with a difference in average net cost of £1,474 at 12 months.
The authors said: ‘Further research is needed to understand why the Lightning Process improves outcomes at six and 12 months and which aspects contribute to its effectiveness.’
Arch Dis Child 2017, online 20 Sep
CHD risk awareness ‘lower for women’
Women may be less cognisant than men of the importance of taking medication following a heart attack or a stroke, according to a new study.
Researchers looked at data from 10,000 heart disease patients and found women were 50% less likely than men to achieve total cholesterol targets, and less likely to achieve LDL-cholesterol and glucose targets.
They were also less likely than men to be physically active and to attend cardiac rehabilitation, and had lower overall risk factor management scores.
The researchers noted that sex differences in achieving lipid targets were larger in younger women than older women, leaving younger patients at a particular disadvantage.
The researchers said: ‘Women may pay less attention to their CHD risk factor management, resulting in less cardiovascular medication being used and fewer targets being achieved.
‘This is unfortunate as clinical guidelines recommend… preventative medications and a strategy of CHD prevention for all patients, irrespective of age, sex, or severity of disease.’
BMJ 2017, online 20 Sep
Tool could ‘improve bowel screening’
A new algorithm used to detect bowel cancer risk based on blood test results could improve the accuracy of colorectal cancer screening, according to new research.
The algorithm identifies patients at risk of bowel cancer by looking for subtle changes in FBCs.
Researchers used the algorithm on a large UK dataset to determine how accurate it was at predicting their risk of colorectal cancer.
They found that it had a positive predictive value of around 9%, meaning that there is a 9% probability that patients who score positively for colorectal cancer risk are truly at risk of being diagnosed within two years. NICE recommends that a positive predictive value of 3% for suspected cancer should trigger referral.
The algorithm also showed good accuracy in distinguishing those who were from those who were not at risk of getting colorectal cancer.
Professor Julietta Patnick, a visiting professor in cancer screening at the University of Oxford and one of the authors, said: ‘The beauty of this algorithm is that it is a system which can be applied to GP surgery data, running quickly and efficiently to give a more accurate level of risk.’
Cancer Medicine 2017, online 21 Sep
GP caution urged in antibiotics for asthma
GPs may find it difficult to distinguish between an infection and asthma exacerbation, leading to overprescription of antibiotics, according to researchers in the Netherlands.
The study looked at data for about two million children from the UK and the Netherlands. It found that children with asthma were about 60% more likely to be prescribed antibiotics than children without the condition.
It also showed antibiotic prescription rates overall were about twice as high in the UK as in the Netherlands, despite both countries following the same international guidelines for asthma treatment.
The researchers suggested that the study may indicate that there is a wider problem of antibiotic overprescription for asthma in European countries.
RCGP honorary secretary Professor Nigel Mathers said: ‘GPs can still come under a lot of pressure to prescribe antibiotics, particularly from worried parents who want a speedy solution when their child is sick
‘There is certainly a need for more public awareness that antibiotics are not the best treatment for all conditions, and if bacteria build up resistance to them through inappropriate use, then these important drugs might not work when they really do need them.’
European Respiratory Society International Congress presentation, Sep 2017