ILD/IPF

Morphine may help persistent coughing in idiopathic pulmonary fibrosis (IPF). The PACIFY COUGH trial found that two weeks of long-acting oral morphine significantly reduced the severity and frequency of coughing by up to 50 percent.

“That’s quite substantial,” explained Deborah Assayag, MDCM, MAS, assistant professor of medicine and member of the division of experimental medicine at McGill University, Montreal, Canada. “This is the first randomized controlled trial to report the benefit of morphine for cough in IPF.”

EVER-ILD was the first-ever trial of combination immunosuppression in patients with non-specific interstitial pneumonia. Combining rituximab with mycophenolate mofetil significantly reduced FVC decline and extended progression-free survival compared with mycophenolate alone.

New guidelines in scleroderma interstitial lung disease (ILD) strongly favor mycophenolate. Conditional recommendations support cyclophosphamide, rituximab, tocilizumab, nintedanib, and nintedanib plus mycophenolate. However, more research is needed for pirfenidone and pirfenidone plus mycophenolate.

Medical Education

Medical trainees amass an average of $200,000 in education debt, making lessons in financial wellness a crucial consideration for their future. A trial curriculum covering student loans, investments, insurance, retirement savings, budgeting, debt management, and general personal finance reportedly eased the depressive symptoms associated with debt. Reducing depression may reduce burnout, among other benefits.

“Having some sort of financial literacy training resulted in better feelings of well-being,” reported Diana Kelm, MD, medical director for the Multidisciplinary Simulation Center at the Mayo Clinic.

She recommended that trainees partner with financial professionals who have more comfort and expertise in the field than many physicians.

Sepsis

“Sepsis is a challenge,” said Ithan Peltan, MD, MSc, associate professor of pulmonary and critical care medicine at the University of Utah, and medical director of acute care and PCCM research at Intermountain Health. “We have no proven treatment because we have a syndrome, not a single disease.”

Starting antimicrobial treatment earlier can help reduce mortality, particularly in patients exhibiting septic shock. When giving antimicrobials within an hour of definite or probable diagnosis, the number needed to treat (NNT) for septic shock is 50 and 200 for sepsis. However, because sepsis is far more common, giving antimicrobials in an hour or less saves more patients with sepsis than those with septic shock.

Expanding the antimicrobial window to three hours reduces overall 30-day mortality by 1.2 percent.

The ACORN trial found no difference in outcomes between cefepime vs. piperacillin-tazobactam for acute infection.

A comparison of fludrocortisone combined with hydrocortisone versus hydrocortisone alone for septic shock showed a 3.7 percent survival rate advantage favoring combination treatment.

Occupational and Environmental Lung Disease

Wildfire smoke dramatically increases atmospheric PM2.5 levels and emergency department (ED) visits for asthma. An analysis of New York City air quality, ED visits, and wildfire smoke showed a 12 percent increase in PM2.5 levels and acute asthma-related ED visits but did not increase alternative types of respiratory visits.

“This was a one-time event, but these findings are replicated in other studies,” said Sheiphali Gandhi, MD, MPH, assistant professor of occupational, environmental, and climate medicine at the University of California San Francisco, who presented virtually.

Retrospective data from California show a strong relationship between working with engineered stone and silicosis. Among workers exposed to engineered stone with silicosis, 36 percent died from silicosis at a mean age of 46, and 82 percent were referred for lung transplantation.

The presentation also noted that U.S. veterans who served in Iran and were exposed to mustard gas have a higher rate of respiratory disease than the general population and abnormal spirometry at the time of death.