Respiratory Care Currents

 Published: November 2, 2021

By: Debbie Bunch


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Industry Group Urges COVID, Flu Vaccines

According to the members of the Critical Care Societies Collaborative (CCSC), it’s never been more important for health care workers to get their annual flu shot, along with their COVID-19 vaccine. Noting that this year’s flu season could be particularly active, especially with the waning of adherence to COVID-19 preventative measures such as mask wearing, the group is asking everyone to get vaccinated against both COVID-19 and the flu. Our chronic lung disease patients should also be encouraged to receive these vaccinations.   

“Influenza and the COVID-19 vaccinations help individuals protect themselves and their communities,” said Beth Wathen, MSN, RN, CCRN-K, president of the American Association of Critical-Care Nurses, which is one of the member organizations of the CCSC along with the American College of Chest Physicians, American Thoracic Society, and Society of Critical Care Medicine. “For those who are eligible, vaccination supports the best health outcomes for everyone. Flu vaccination can reduce the number of patients who need hospitalization and lessen their impact on a health care system already overburdened by caring for those with COVID-19.” 

Small Molecule Linked to Airway Constriction

Researchers from Rutgers and Yale have discovered that a protein found in the cell membranes of smooth muscles in the lungs of patients with chronic airway disease can leak cyclic adenosine monophosphate (cAMP), a small molecule that restricts breathing. The discovery may lead to more effective bronchodilators for conditions like asthma and COPD. 

“This protein has been recognized as important in some diseases, but it has never been defined before in airway diseases, such as asthma and COPD, until now,” said co-author Reynold Panettieri, vice chancellor of translational medicine at Rutgers. “In addition to identifying this protein, we demonstrated that if you decrease the leakage, the smooth muscles in the airways relax, which could be potentially very important in improving asthma and COPD management.” 

The investigators also believe measuring cAMP in the blood could serve as a new biomarker that can help identify specific types of asthma and COPD. The study was published in the American Journal of Respiratory Cell and Molecular Biology  


Switching to E-Cigarettes May Not Be Keeping Smokers from Relapsing

The CDC has suggested that switching to e-cigarettes would benefit smokers of traditional cigarettes, but only if they can switch completely and never go back to smoking traditional cigarettes.  

According to San Diego investigators publishing in JAMA Network Open, that is much harder than it sounds. Their study was based on data from the Population Assessment of Tobacco and Health longitudinal study and involved 13,604 smokers who completed two consecutive annual surveys on their use of 12 tobacco products. The results showed —  

  • At the first annual follow up, 9.4% of smokers had quit.  
  • 62.9% of that group remained tobacco free, while 37.1% had switched to another form of tobacco use.  
  • Among those who switched to another product, 22.8% used e-cigarettes, with 17.6% of switchers using e-cigarettes daily. 
  • Recent former smokers who switched to e-cigarettes were more likely to be non-Hispanic white, have higher incomes, have higher tobacco dependence scores, and view e-cigarettes as less harmful than traditional cigarettes. 
  • At the second annual follow up, those who switched to any other form of tobacco use, including e-cigarettes, were more likely to relapse compared to former smokers who had quit all tobacco. 
  • Among recent former smokers who abstained from all tobacco products, 50% were 12 or more months off cigarettes at the second follow up and were considered to have successfully quit smoking; this compared to 41.5% of recent former smokers who switched to any other form of tobacco use, including e-cigarettes. 
  • While individuals who switched were more likely to relapse to smoking, they were also more likely to attempt to quit again and be off cigarettes for at least three months at the second follow up.  

“This is the first study to take a deep look at whether switching to a less harmful nicotine source can be maintained over time without relapsing to cigarette smoking,” said first author John P. Pierce, PhD, from UC San Diego. “If switching to e-cigarettes was a viable way to quit cigarette smoking, then those who switched to e-cigarettes should have much lower relapse rates to cigarette smoking. We found no evidence of this.” 

Ferritin Levels Linked to Outcomes for COVID-19 Pneumonia

Why do some patients with COVID-19 pneumonia fare better than others? Researchers from the Renaissance School of Medicine at Stony Brook University believe blood serum levels of ferritin, which is an indicator of body iron stores and can rise markedly with acute infections, may hold a clue. 

They looked at ferritin levels in 380 non-intubated patients with severe COVID-19 pneumonia, 142 of whom had received the corticosteroid methylprednisolone to reduce lung inflammation, along with high-flow oxygen therapy. Among those patients with the highest level of ferritin, methylprednisolone was associated with approximately 80% lower mortality and more than 50% lower risk of the composite end point of death or mechanical ventilation at 28 days.  

No benefit from methylprednisolone was seen in patients with medium or low levels of ferritin.  

“Our results need to be interpreted with caution as it is an observational study but it supports an important hypothesis — we could use ferritin, and perhaps other inflammatory blood markers to see who needs corticosteroids among patients admitted for COVID-19 pneumonia in an attempt to prevent intubation and death,” said study author Andreas Kalogeropoulos, MD, MPH, PhD. 

The study was published by JAMA Network Open 

A Better Respirator?

The pandemic has shined a bright light on personal protective equipment for health care professionals. A new study out of Great Britain suggests a novel type of respirator is both safe and effective for frontline workers.   

The prototype reusable, battery-powered respirators, also known as PeRSo, were developed early in the pandemic at the University of Southampton and University Hospital Southampton as an alternative to single use respirators. The devices come with a waist-mounted rechargeable battery-powered unit that effectively filters air and then blows clean air into a loose-fitting hood with a clear visor.  

A study published in Frontiers in Medical Technology found that the respirators were significantly preferred by staff and patients alike, with staff perceiving them as more comfortable and safer, and patients citing the ability they gave them to see the faces of their providers.  

 The devices were more cost effective than traditional respirators as well, and since they are reusable, they reduced the environmental impact of the disposable PPE. 


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Debbie Bunch

Debbie Bunch is an AARC contributor who writes feature articles, news stories, and other content for Newsroom, the AARC website, and associated emailed newsletters. In her spare time, she enjoys reading, traveling, photography, and spending time with her children and grandchildren. Connect with Debbie by email or on AARConnect or LinkedIn.

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