CHEST Guidelines-Response_chest_18

Response_chest_18 - 1

Pdf Summary

The provided text comprises two separate correspondence pieces discussing medical investigations and findings. The first correspondence, authored by Li-Ta Keng, MD, emphasizes the use of the "shifting gas sign" in ultrasonography to diagnose pneumoperitoneum, especially when transportation for CT imaging is not feasible. This technique involves observing the movement of free air in the abdomen when a patient's position is changed. It's a portable and rapid diagnostic method that can be particularly useful in emergency scenarios. The authors from Stony Brook University agree with this assessment, noting that while existing signs like the "gut point" can be specific, they have low sensitivity. They endorse the inclusion of the shifting gas sign in diagnostic protocols, citing its utility in distinguishing intraluminal gas from intraperitoneal gas.<br /><br />The second correspondence, by Brian Lipworth and colleagues, critiques a study by Suissa et al., which analyzed the effectiveness of combining a long-acting muscarinic antagonist, long-acting beta-agonist, and an inhaled corticosteroid (ICS) for treating chronic obstructive pulmonary disease (COPD). The authors point out that Suissa's analysis between 2002 and 2015 cannot fully reflect current practices, as triple therapy is now available in a single inhaler format, potentially improving adherence. They suggest reanalysis using combined criteria of eosinophil levels and exacerbation frequency. Suissa et al., in their response, acknowledge the benefits of LAMA-LABA-ICS over LAMA-LABA, particularly in patients with eosinophilia or frequent exacerbations but cite limited sample sizes as a barrier to further analysis.<br /><br />Both correspondences underscore advancements and challenges in diagnostic and treatment methodologies, advocating for updates to current practices based on emerging evidence and technology.

Keywords

shifting gas sign

ultrasonography

pneumoperitoneum

emergency diagnosis

chronic obstructive pulmonary disease

triple therapy

long-acting muscarinic antagonist

long-acting beta-agonist

inhaled corticosteroid

eosinophilia