Cover Article
Cataracts: Another Reason to Lower the IC Dosage
It is well established that systemic corticosteroids increase the risk of cataracts. Now, a new study has shown that inhaled corticosteroids, when used at high doses and for a long duration, also raise the likelihood of cataract development.

Selected Articles

• Primary Pulmonary Hypertension: A Form of Malignancy?
• Metapneumovirus: A Major Cause of Respiratory Illness
• Engineering a New Approach to Septic Shock
• Antibiotic-Impregnated Catheters Cut Bloodstream Infection Rate
• Hearing Impairment Common in the ICU
• Simple Changes Can Improve Speech in Ventilator Patients
• Conference News Update: Annual Congress of the European Respiratory Society
• Literature Monitor

Cover Article
Getting CAP Patients on Their Feet
Could staying in bed be bad for the health of patients with community-acquired pneumonia (CAP)? Approximately 15% of such patients require hospitalization, at an annual cost to the US of $4 billion. A team of researchers from Washington University in St. Louis has now found that this simple intervention shortens hospital stays by one day and reduces costs.

Selected Articles

• Childhood Wheezing May Affect Lung Function in Adulthood
• Mortality in SARS Patients Was Higher Than Reported
• Cough Peak Flow Gauges Extubation Readiness
• Pulmonary Embolism Mortality Steadily Declining
• Noninvasive Ventilation Helpful for Persistent Weaning Failure
• Corticosteroids and IPF—To Treat or Not to Treat?
• Sildenafil for Pulmonary Hypertension?
• Literature Monitor

Cover Article
Rat Allergen and Asthma in the Inner City
Does exposure to rats increase the risk of asthma among inner-city residents? Until recently, this question has received surprisingly little attention. However, new data suggest that rat allergen is common in inner-city homes and that sensitization to it significantly increases asthma morbidity.

Selected Articles

• The ß-Agonist Paradox: New Findings
• Dalteparin Monotherapy a Key Intervention for Cancer Patients
• IV N-Acetylcysteine as Good as Oral, Inhaled Preparations
• Noninvasive PSV May Obviate ICU Admission for Cardiogenic Pulmonary Edema
• “Trif” Protein Helps Explain Immune Response to Infection
• Long-term Pulsed NO Inhalation for COPD
• Literature Monitor

Cover Article
Arginase Pathway Suggests New Approaches to Asthma Therapy
Gene microarray technology has revealed up-regulation of the enzyme arginase in two distinct models of experimental asthma—and in the lungs of asthma patients. Up-regulation of arginase occurs in response not only to allergens but also to interleukins 4 and 13, cytokines thought to be central to development of the asthma phenotype. The findings point to new targets for asthma therapy.

Selected Articles

• CYP2A6 DEL Keeps Smokers Smoking—But Protects Against COPD
• Dynamic MRI Enables Airway Visualization
• Plasma Exchange Improves Survival in Severe Sepsis
• Tifocogin Fails to Increase Long-term Sepsis Survival
• Therapeutic Hypothermia for Traumatic Brain Injury: Getting It Right
• Literature Monitor

Cover Article
Exploring the Role of Mold in Asthma
Exposure to mold, whether indoors or outdoors, seems to play a part in the development or worsening of respiratory problems, including asthma. Although researchers generally agree that mold affects respiratory health, they are uncertain if it is the mold itself that causes symptoms or the dust mites that flourish in damp environments. Furthermore, if mold is the culprit, exactly how does it affect the lungs?

Selected Articles

• Inhaled Corticosteroids Don’t Slow FEV1 Decline in COPD
• Predicting Risk in Pulmonary Embolism
• Battling Pneumonia—and Resistance—in the ICU
• Corticosteroids for Septic Shock and ARDS: Back to the Future?
• Low BMI Adversely Affects ICU Outcomes
• New Patient Safety Practices Released
• Literature Monitor

Cover Article
Childhood Asthma “Epidemic” Reported in Harlem
The Harlem Children’s Zone Asthma Initiative, an ongoing, intensive effort to test and treat for asthma every child living within a 24-block area of Harlem, has revealed an unprecedented asthma prevalence of 25.5%. Although several factors could contribute to this childhood asthma “epidemic,” clinicians and public health researchers are focusing on how to reduce the shockingly high rate.

Selected Articles

• NETT Findings Clarify LVRS Risks, Benefits, Costs
• Reeve Testing New Diaphram Nerve Pacing Device
• How Ventilation Leads to MODS in ARDS Patients
• TRL4 Mutations Increase Meningococcal Sepsis Risk
• COPD and CV Risk: What’s the Connection?
• Asthma May Lead to Irreversible Airway Obstruction
• Literature Monitor

Cover Article
Asthma Phenotype, Genotype May Guide Future Therapies
The early environment may be important in determining whether a child develops atopy or asthma, but children’s responses to their environment are not all alike: The disease phenotype may be determined by genetic background as well as by exposure.

Selected Articles

• Infection Control in the Time of SARS
• Coagulation and Inflammation: Interrelated Response to Infection
• Carbon Monoxide: Future Therapy?
• Predicting the Risk of Sepsis-Related Mortality in the ED
• Hypertonic Fluids for Sepsis and Shock: Ready for Prime Time?
• Optimizing Outcomes in VAP
• Literature Monitor

Cover Article
A Close Look at the Clinical Course of SARS
As the severe acute respiratory syndrome (SARS) spreads around the world, physicians must learn to recognize its early symptoms and to understand its clinical course. This report provides details about SARS’s signs, symptoms, lab abnormalities, and radiologic findings.

Selected Articles

• Two Effective Approaches to VTE Prophylaxis
• Helical CT: Cost-effective in Lung Cancer and PE?
• New Drugs for Hemorrhage and HIT
• In Septic Shock, Increase Cardiac Output or Leave It Alone?
• Weighing in on Antibiotic Restrictions in the ICU
• Likely Cause of SARS Identified
• Literature Monitor

Cover Article
Deaths from Flu and RSV Increasing
Deaths from influenza and respiratory syncytial virus increased significantly between 1976 and 1999. The elderly segment of the population—those 65 and older—had the highest rates of mortality from these diseases.

Selected Articles

• Sleep-Disordered Breathing Linked to Parasomnia in Kids
• Even Low ETS Exposure Reduces Vitamin C in Children
• No Benefit to PACs in Elderly Surgical Patients
• More Evidence for the Benefits of Strict Glycemic Control
• Diuretic, LMWH Use During Renal Impairment
• Monitor Fluid Balance With Chest Films?
• How Group A Streptococci Evade Phagocytosis
• Not-So-High-Altitude Pulmonary Edema
• Cause or Effect: Gray Matter Loss in OSA Patients
• Literature Monitor

Cover Article
Eosinophil Counts: A Better Marker for Asthma Management
Monitoring asthma symptoms is necessary for ongoing, efficient disease management. A new study suggests that using sputum eosinophil counts may be more effective than using traditional methods to make decisions on adjusting treatment.

Selected Articles

• “Real World” Study Addresses Early Inhaled Steroid Use in Mild Asthma
• Pertussis Outbreak at an Oil Refinery
• Lessons From the Bronchoscope Recall
• Risk Factors for Paresis After Ventilation
• For Atrial Fib, Should You Control Rate or Rhythm?
• Reflectometry Can Improve Endotracheal Tube Replacement
• Esophageal Cancer Resection: How Much Is Enough?
• When Sampling Pleural Fluid, Less May Be More
• Bacterial Extract Limits Recurrent URTIs
• Literature Monitor
• Therapeutic Bulletin: Optimizing Analgesia and Sedation for the Mechanically Ventilated Patient

Cover Article
COPD and Incidence of Osteoporosis
Osteoporosis occurs more frequently in people with COPD than in those with asthma, despite greater corticosteroid use in asthma. This study looks at causative factors in both groups, including low body mass index (BMI), malnutrition, and smoking—as well as COPD itself.

Selected Articles

• ß1-Blockers Safe in Reactive Airway Disease
• Preventing Influenza in Children: Goals and Issues
• HIV Superinfection Despite Strong Immune Response
• Bad Blood: Battling Anemia in the ICU
• Alcohol Increases ARDS Risk, Severity
• CDC Releases New Guidelines on Hand Hygiene
• Insulin Eases Lung Diffusion in Diabetic Patients With Heart Failure
• Sildenafil for PH with Lung Fibrosis
• The Connection Between Ig Deficiency and ILD

Cover Article
Can Christopher Reeve Get Off the Ventilator?
Actor Christopher Reeve is making an unprecedented recovery from his 1995 spinal cord injury. He has already regained sensory function in more than 70% of his body as well as 20% of his normal motor function. Now his focus is to breathe entirely on his own. Read about the novel therapy behind his continuing recovery.

Selected Articles

• Jury Out on Asthma Action Plans
• What Causes COPD in Nonsmokers?
• Dexamethasone for Adult Bacterial Meningitis
• Adrenal Insufficiency: Underdiagnosed in the Critically Ill
• Intensivists Improve ICU Outcomes
• Unsuspected Cardiac Abnormailites in the MICU
• Alteplase for Submassive PE?
• A Look Inside: Semirigid Pleuroscopes
• Literature Monitor