CHEST Guidelines-Confirm,-Don’t-Conform-Toward-Thrombolysis-

Confirm,-Don’t-Conform-Toward-Thrombolysis-

Pdf Summary

The document focuses on the risks associated with inhaled corticosteroids (ICS) in treating chronic obstructive pulmonary disease (COPD), particularly concerning the increased risk of pneumonia. It highlights findings from various studies, including one that indicates a relatively higher risk of pneumonia with fluticasone use compared to budesonide. Fluticasone was linked to a 74% higher risk of pneumonia when compared to budesonide. Furthermore, in a cohort study involving more than 160,000 patients with COPD, the adjusted rate ratios demonstrated that fluticasone propionate users had a higher rate of serious pneumonia requiring hospitalization than non-users.<br /><br />The document also mentions a meta-analysis by Wang et al., showing that triple therapy involving beclomethasone might not increase pneumonia risk, though the study lacks radiographic confirmation of pneumonia, bringing its accuracy into question. Conversely, larger observational studies have indicated a significant risk of serious pneumonia with ICS use, including beclomethasone.<br /><br />The second part refers to a study on out-of-hospital cardiac arrest (OHCA) linked to pulmonary embolism (PE), examining the effects of thrombolysis during resuscitation. While thrombolysis was associated with improved survival, methodologic concerns were noted. The lack of early termination and absence of acute right ventricular dysfunction confirmation raised questions. Also, the study period aligns with guidelines for PE management, suggesting contraindications for thrombolysis possibly affected outcomes. The author responds, clarifying that resuscitation was performed by mobile ICU units on-site, ensuring robust inclusion criteria for the study.<br /><br />Overall, the document emphasizes the need to cautiously interpret findings regarding ICS and thrombolysis use, noting discrepancies and potential biases in studies that could influence clinical outcomes.

Keywords

inhaled corticosteroids

chronic obstructive pulmonary disease

pneumonia risk

fluticasone

budesonide

cohort study

triple therapy

beclomethasone

out-of-hospital cardiac arrest

thrombolysis