Festić, Emir

Abstract Introduction The World Health Organization (WHO) has categorized pulmonary hypertension (PH) in five groups. Obstructive sleep apnea (OSA) is an independent cause of group 3 PH. The prevalence of OSA in PH patients is approximately 20% and untreated OSA may contribute to pulmonary vascular remodeling, exacerbating PH. Regular use of positive airway pressure (PAP) can improve pulmonary artery pressures. We hypothesized that untreated OSA is associated with mortality in all five groups of PH, and that mortality is reduced with PAP therapy. Methods We performed a retrospective chart review of the PH patient registry at Mayo Clinic Jacksonville, comprised of 696 patients classified per WHO classification of PH. Mortality in each WHO group of PH was abstracted as well as the presence of OSA as a comorbidity. Compliance with positive airway pressure therapy (PAP) was assessed across all patients with OSA. Results Patients in the registry were followed for a mean of 101.2 months. The mortality across all groups was 36.8%, ranging from 22.6% in group 4 to 64.3% in group 5. OSA was present in 46.9% patients, and it ranged from 33% in group 5 to 58% in group 2. Mortality did not vary significantly in the patients with OSA versus those without OSA (p=0.56). Of patients with OSA, 45.9% was deemed compliant with PAP therapy. Overall, the compliant patients had reduced mortality compared to the noncompliant ones (p=0.045), however this significance was due to pronounced effect in group 1 patients only. Conclusion Almost half of PH patients from our registry had OSA. Compliance with PAP therapy was associated with lesser mortality, primarily due to the effect seen in Group 1 PH patients. Support (if any)

Community-acquired pneumonia is still a major cause of morbidity and mortality worldwide. Since the inflammatory response induced by the immune system is often a major contributor to the lung injury, it becomes reasonable to assess the potential benefit of anti-inflammatory agents in treating community-acquired pneumonia. The role of corticosteroids as adjunct anti-inflammatory agents in treating community-acquired pneumonia is still controversial. Several studies have assessed the benefit of their use in patients with community-acquired pneumonia. In most of those studies, the route of corticosteroids administration was systemic. The aim of this article is to provide a concise review of the role of corticosteroids in treating community-acquired pneumonia when administered via inhalational route, with the potential benefit of avoiding systemic side effects of corticosteroids while exerting the same anti-inflammatory effects on the lungs. Conclusion: the use of inhaled corticosteroids may be of benefit in certain patient subsets with community-acquired pneumonia. Further randomized controlled trials are needed for better determination of such patient subsets.

Abstract Patients hospitalized for pneumonia are at high risk for mortality. Effective therapies are therefore needed. Recent randomized clinical trials suggest that systemic steroids can reduce the length of hospital stays among patients hospitalized for pneumonia. Furthermore, preliminary findings from a feasibility study demonstrated that early treatment with a combination of an inhaled corticosteroid and a bronchodilator can improve oxygenation and reduce risk of respiratory failure in patients at risk of acute respiratory distress syndrome. Whether such a combination administered early is effective in reducing acute respiratory failure (ARF) among patients hospitalized with pneumonia is unknown. Here we describe the ARREST Pneumonia (Arrest Respiratory Failure due to Pneumonia) trial designed to address this question. ARREST Pneumonia is a two-arm, randomized, double-blinded, placebo-controlled trial designed to test the efficacy of a combination of an inhaled corticosteroid and a β-agonist compared with placebo for the prevention of ARF in hospitalized participants with severe pneumonia. The primary outcome is ARF within 7 days of randomization, defined as a composite endpoint of intubation and mechanical ventilation; need for high-flow nasal cannula oxygen therapy or noninvasive ventilation for >36 hours (each alone or combined); or death within 36 hours of being placed on respiratory support. The planned enrollment is 600 adult participants at 10 academic medical centers. In addition, we will measure selected plasma biomarkers to better understand mechanisms of action. The trial is funded by the U.S. National Heart Lung and Blood Institute. Clinical trial registered with www.clinicaltrials.gov (NCT 04193878).