Risk of pneumonia with budesonide-containing treatments in COPD: an individual patient-level pooled analysis of interventional studies.

Background: Concerns have been raised that treatment of COPD with inhaled corticosteroids may increase pneumonia risk. Responding to a request from the European Medicines Agency Pharmacovigilance Risk Assessment Committee, a pooled analysis of interventional studies compared pneumonia risk with inhaled budesonide-containing versus non-budesonide-containing treatments and the impact of other clinically relevant factors.

Methods: AstraZeneca-sponsored, parallel-group, double-blind, randomized controlled trials meeting the following criteria were included: >8 weeks' duration; ≥60 patients with COPD; inhaled budesonide treatment arm (budesonide/formoterol or budesonide); and non-budesonide-containing comparator arm (formoterol or placebo).

Lower incidence of CMV infection and acute rejections with valganciclovir prophylaxis in lung transplant recipients.

Background: Cytomegalovirus (CMV) is the most common opportunistic infection following lung transplantation. CMV replication in the lung allograft is described as accelerating the development of bronchiolitis obliterans syndrome (BOS). Finding a strategy to prevent CMV infection is an important issue.

Prediction of BOS by the single-breath nitrogen test in double lung transplant recipients.

Background: The present study analyses the ability of the alveolar slope of the single-breath nitrogen washout test (N2-slope) to diagnose and predict the development of the bronchiolitis obliterans syndrome (BOS).

Methods: We present a retrospective analysis of 61 consecutive bilateral lung or heart-lung transplant recipients who were followed at regular control visits during a three year follow-up. The operating characteristics of the N2-slope to diagnose BOS and potential BOS (BOS 0-p) and to predict BOS were determined based on cut off values of 95% specificity.

Cytomegalovirus and long-term outcome after lung transplantation in Gothenburg, Sweden.

Prophylaxis with ganciclovir has decreased the initially high morbidity related to cytomegalovirus (CMV) after lung transplantation, but the optimal length of prophylaxis and the long-term outcome have not yet been established. The impact of CMV on the short- and long-term outcome was studied in 187 lung transplant recipients in Gothenburg, Sweden, 1990-2002. Among CMV-seronegative patients receiving grafts from seropositive donors (D+/R-), 88% developed CMV disease, 40% if both donor and recipient were CMV-seropositive (D+/R+) and 26% if only the recipient was CMV-seropositive (D-/R+).

Pulmonary hemodynamics as predictors of mortality in patients awaiting lung transplantation.

Lung transplantation (LTx) is a therapeutic option for patients with end-stage lung disease. However, the mortality rate of patients on the waiting list is high. The purpose of this study was to examine the prognostic value of cardio-pulmonary hemodynamics for death in patients awaiting LTx.

BMPR2 gene rearrangements account for a significant proportion of mutations in familial and idiopathic pulmonary arterial hypertension.

Mutations of the BMPR2 gene predispose to pulmonary arterial hypertension (PAH), a serious, progressive disease of the pulmonary vascular system. However, despite the fact that most PAH families are consistent with linkage to the BMPR2 locus, sequencing only identifies mutations in some 55% of familial cases and between 10% and 40% of cases without a family history (idiopathic or IPAH). We therefore conducted a systematic analysis for larger gene rearrangements in panels of both familial and idiopathic PAH cases that were negative on sequencing of coding regions.

New-onset cardiovascular risk factors in lung transplant recipients.

Background: Cardiovascular disease (CVD) is a common cause of morbidity and mortality after solid-organ transplantation. Both pre-existing cardiovascular risk factors in recipients and immunosuppressive drug toxicity may contribute to CVD. We sought to describe the prevalence of new-onset hypertension, hypercholesterolemia and diabetes mellitus in lung transplant recipients and to identify predisposing factors.

Detection of chronic rejection by quantitative ventilation scintigrams in lung-transplanted patients: a pilot study.

The suspicion of chronic rejection [bronchiolithis obliterans syndrome (BOS)] is usually based on deteriorating forced expired volume in 1 s. It is however, desirable to develop more sensitive methods as increased anti-inflammatory therapy is thought to stop progression of the rejection. The aim of the present study was to develop quantitative tools based on ventilation scintigrams, to diagnose BOS.