By Debbie Bunch
January 27, 2025
Contemporary LVRS Gets Good Marks
Researchers presenting at the Society of Thoracic Surgeons Annual Meeting suggest contemporary lung volume reduction surgery (LVRS) outperforms endobronchial valve (EBV) placement for people with severe emphysema.
The investigators based that conclusion on an evaluation of data on all beneficiaries in the CMS inpatient claims database who had severe emphysema and underwent either LVRS or EBV between January 1, 2019, and December 31, 2022. Overall, 3,219 patients were included in the study, with 2,378 receiving LVRS (1,897 via minimally invasive video-assisted thoracoscopic or robotic surgeries and 481 via open surgeries) and 841 receiving EBV placement.
Even though the EBV patients had shorter hospital stays, lower hospital charges, and lower Elixhauser Comorbidity Index scores before risk adjustment, they ultimately had more complications and a higher longitudinal risk of death than those who received LVRS.
The authors note that EBV was developed as an alternative to LVRS when early studies showed a high mortality rate for the surgery. However, as surgical procedures have evolved, the risks associated with LVRS have lessened.
“The potential of surgical volume reduction was duly explored in the late 1990s in patients with severe emphysema,” explained study author J. W. Awori Hayanga, MD, MPH, professor of thoracic surgery at West Virginia University. “The surgical approach, however, did not gain broad popularity because of the high mortality of 8% and the small group of patients believed to benefit from the procedure.”
Given the findings of this new study, he and his colleagues believe it is time to revisit multidisciplinary decision-making regarding the role that surgery over EVB can play in treating patients with advanced emphysema.
“Outcomes after surgery were better than previously reported and were often better than those after valve placement,” said Dr. Hayanga. “It is likely that patients do far better after surgery than they used to.” Read Press Release
Blood Test May Be on the Way for Asthma
Diagnosing asthma is a complicated process, often involving myriad pulmonary function tests.
Researchers from Rutgers University believe a simple blood test may soon be able to quickly and easily identify those with the condition. The test looks for levels of a molecule known as cyclic adenosine monophosphate (cAMP), which is significantly elevated in people with asthma.
“What we discovered is a specific transporter, a protein on the membrane of airway smooth muscle cells, allows cAMP to leak into the blood,” said senior study author Reynold Panettieri. “For decades, we believed that an enzyme called phosphodiesterase was the critical factor in decreasing cAMP. We now refute that and say this transporter leaks it out.”
The study was conducted among 87 asthma patients and 273 people without asthma. Blood levels of cAMP were consistently higher in asthma patients — often up to 1,000 times higher — and were correlated with disease severity. The latter finding could also make the test useful in monitoring patient conditions over time.
Dr. Panettieri and his colleagues believe a blood test for asthma would be especially helpful in diagnosing young children who have difficulty completing pulmonary function tests and in urban areas, where the rate of asthma is exceptionally high.
The team is currently working with companies to develop a point-of-care test that could be used in physician’s offices, and they also plan more extensive studies to look at how cAMP levels relate to different asthma subtypes, with an eye toward developing more personalized treatment approaches for people with asthma in the future.
The Journal of Clinical Investigation published the study. Read Press Release Read Paper
Medication Plus Counseling Best at Helping People Quit Smoking
Integrated care consisting of medication and comprehensive counseling delivered by a tobacco treatment specialist may be the best way to help smokers who undergo lung cancer screening to kick the habit, report researchers from MD Anderson Cancer Center.
They arrived at that finding after randomizing 630 current smokers who were eligible for lung cancer screening to either a quitline referral and nicotine replacement therapy (NRT) (QL); a quitline referral plus NRT or medication prescribed by a lung cancer screening clinician (QL+); or integrated care (IC), which included NRT or prescription pharmacotherapy and counseling provided by a team of tobacco treatment specialists and physicians.
At a three-month follow-up, the researchers found that patients in the IC group had the highest quit rate, at 37.1%. That compared to 27.1% in the QL+ group and 25.2% in the QL group. Patients in the IC group also maintained the highest quit rate after six months, coming in at 32.4% vs. 27.6% for the QL+ group and 20.5% for the QL group.
“Facilities equipped to provide dedicated and integrated care should prioritize doing so to offer patients the best opportunity for smoking cessation and improved health outcomes,” said study author Paul Cinciripini, PhD. “Given our results, it is conceivable that this approach could also be highly effective outside a screening environment, such as post-traumatic stress clinics and among patients with cancer, cardiovascular disease, or diabetes.”
JAMA Internal Medicine published the study. Read Press Release Read Abstract
