Posts tagged Chest

Week Beginning 08-03-10

1
1168 days
by in Timetable

DundeeChest returns to work! So back again are the weekly updates of what’s coming up in the chest department.

Monday
Dr Fardon has an all day clinic
Dr Winter has a morning clinic
Dr France has an afternoon clinic
Dr Brown has an afternoon bronch list

Tuesday
Dr Stretton has a morning clinic
Dr Smith has a morning clinic
Dr Fardon is doing a ward round
Dr Smith has a sleep clinic in the afternoon

Wednesday
Dr Fardon has a morning bronch list
Dr Smith has a morning clinic
Dr Fardon is doing a morning ward round, somehow
Dr Fardon will be teaching anyone who turns up at 3.

Thursday
There is no CF clinic this week, as there’s a CF conference in town
Dr France will be doing a ward round
There is a medical grand round at 1
Lung cancer MDT at 2

Friday
Someone will be doing a ward round in the morning
Someone will be doing a bronchoscopy list in the morning
There is a respiratory department meeting at 1
Dr Fardon will be teaching anyone who turns up at 3

So a good mix of things, as well as loads of referrals to see, procedures to be done, and general mucking in.

Now that was the last thing we needed……

2
1195 days
by in Featured, General Respiratory

Yes, that is a crystal studded MDI....

A recent paper in Chest has suggested that the staple treatment for COPD may not be the knees of the bees after all.  Inhaled corticosteroids (ICS) have been the cornerstone of COPD management for some time, with the aim of reducing inflammation and (hopefully) cutting exacerbation rate. The TORCH study successfully did away with thoughts of ICS improving survival (ahh, the agony of p=0.052) but at least we have the principle of symptom control to cling to don’t we? Well, don’t we?

The clever bods from Chandigarh, India have taken 11 large prospective, double-blind, randomized, placebo-controlled trials and passed it through their Metaregression-ometer and come up with the conclusion that “The benefits of ICS in preventing COPD exacerbations seems to be overstated”.  The collected statistics from the 8,164 patients pooled from seminal papers including ISOLDE, TRISTAN and TORCH showed that “we did observe a modest benefit of ICS in preventing COPD exacerbations in patients with FEV 1 < 50%. However, this finding was not further substantiated on a metaregression analysis wherein we did not observe a significant effect of baseline values of FEV 1 (percentage predicted) on the benefits from ICS compared with placebo.  Thus, ICS is likely to have only modest benefits in preventing COPD exacerbations, if at all, and should be judiciously used in patients with COPD keeping in mind the risk-benefit ratio.”

I’ll admit my utter ignorance of the nuances of metaregression analysis and its potential flaws when used like this, but I would hope that the use of words such as “likely” and “modest” would hint that the analysis has scope to be challenged by people with more statistical savvy than my good self. Mind you, it doesn’t really matter does it, what with the veritable panacea of COPD drugs at our disposal…………(right, anyone got shares in Roflumilast?).

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