Recognizing asthma in patients with chronic obstructive pulmonary disease.

Newer guidelines for the use of inhaled corticosteroids in chronic obstructive pulmonary disease (COPD) state that they should be reserved for those patients who are likely to derive the greatest benefits from this medication class. This makes the latest Global Initiative for Chronic Obstructive Lung disease (GOLD) guidelines of great importance. This article examines the utility of a previous diagnosis of asthma, the presence of eosinophilia, elevated immunoglobulin E, and positive bronchodilator response in identifying the people with COPD who also have asthma, and it presents two case studies of patients with COPD to illustrate the use of the GOLD guidelines in clinical practice.

Diagnosis and treatment of migraine in the patient with depression.

Background And Purpose: Migraine headache is an enormous health care burden resulting in billions of dollars in workforce revenue lost and millions of lost workdays per year. Migraine headaches and depression are common comorbidities and require expertise in treatment and prevention.

Methods: The aim of this article is to update the nurse practitioner (NP) on best clinical practices for managing the patient with migraine and previously diagnosed depression.

Tiotropium for asthma: A summary of current guidelines and a case study.

Background And Purpose: The long-acting muscarinic antagonist tiotropium received an indication for the treatment of asthma from the FDA in 2015.

Methods: This paper summarizes much of the published findings on tiotropium and asthma and explores the heterogeneity of the asthma population vis-à-vis recent changes in guidelines for management of COPD. The accompanying case study provides an illustration of how tiotropium might be added to a patient's regimen appropriately.

Intravenous magnesium sulfate reduces rates of mechanical ventilation in pediatric asthma.

In this column, we examine an original research article by S. Torres et al. (2012) on the subject of magnesium sulfate use in pediatric patients with acute asthma.

Children with asthma in the ED: timing of corticosteroids.

In the research study "Corticosteroid Timing and Length of Stay for Children With Asthma in the Emergency Department," the authors conducted a retrospective medical record review of children with emergency department (ED) visits to a Connecticut Medical Center in 2007. Their aim was to determine whether administration of oral corticosteroids to patients with acute asthma exacerbation would decrease the mean length of stay in the ED by 10 min or more. We review and critique this article and use a case study module to illustrate the importance of these research findings and also the larger body of evidence supporting the early administration of corticosteroids in acute asthma.

Inhaled corticosteroid prescribing from the emergency department for children with asthma.

In the article "Frequency of Prescription of Inhaled Corticosteroids to Children With Asthma in U.S. Emergency Departments," the authors conducted a secondary data analysis from the National Hospital Ambulatory Medical Care Survey database to examine inhaled corticosteroid prescribing patterns of providers caring for children with asthma visiting emergency departments.

Improving inpatient venous thromboembolism prophylaxis.

Objectives: The number and types of inpatients given inadequate prophylaxis for venous thromboembolism (VTE) are not known; patients receive less than appropriate prophylaxis with some frequency.

Methods: Initially we evaluated VTE prophylaxis at a community hospital by comparing prophylaxis patterns in adult inpatients for whom some prophylaxis was indicated. Patients were categorized as medical, general surgery, and orthopedic, then categorized as "appropriate," "suboptimal," or "none" in terms of VTE prophylaxis.