Chest X-rays unsuitable for silicosis screening

WA has switched to using low dose high resolution CT imaging for screening workers in the engineered stone industry after a study showed that chest X-rays were missing many cases of silicosis.

When 90 workers took up an offer of fully-funded low dose chest CT scans from WorkSafe WA eight had changes consistent with silicosis on their scans, but only one of had an abnormal chest radiograph.

Similarly, 41 workers had CT findings consistent with early lung changes related to silicosis but only three had such findings with chest X-rays.

Presenting the findings at the RACP 2022 meeting, Dr Yijun Yap said the study results showing that only one in eight patients diagnosed with silicosis had abnormalities on chest X-ray prompted legislation change in WA to replace the modality with low dose CT scans as the radiological screening test for occupational exposure to silica.

This included changes such as ground glass infiltrate, isolated lung nodules, some airway abnormalities – basically a picture or airways bronchiolitis which is typically found in smokers but within this cohort was also found in non-smokers. This cohort will therefore require ongoing follow up in the for of serial imaging and possibly respiratory physician input,” she said.

SABA-ICS combination should replace salbutamol as rescue medication

A fixed-dose combination of 180 μg of salbutamol and 160 μg of budesonide is more effective in controlling severe asthma exacerbations than as-needed salbutamol alone.

A phase 3 RCT of over 3,000 patients randomised adolescents from 12 years of age and adults to either the 180/160 ug combination, a combination with a lower budesonide dose (180/80 ug) or 180 μg of salbutamol alone.

The study, published in the NEJM and presented at ATS 2022, found severe asthma exacerbations were significantly lower, by 26%, in the higher-dose combination group than in the salbutamol-alone group (HR 0.74; 95% confidence interval [CI], 0.62 to 0.89; P=0.001).

“The hazard ratio in the lower-dose combination group, as compared with the [salbutamol]-alone group, was 0.84 (95% CI, 0.71 to 1.00; P=0.052),” the study said.

“Given the risks and limitations of SABA alone as rescue therapy, national and international recommendations call for an inhaled glucocorticoid-containing rescue medication as the preferred as-needed treatment; the data from this trial support that approach.”

“Given its acceptable safety profile, the greater efficacy of the fixed-dose combination than of [salbutamol] alone, as well as the absence of a need to change underlying maintenance therapy, indicates that this fixed-dose combination could replace SABA alone as rescue therapy in patients with moderate-to-severe asthma.”

Children 4-11 years in the study were randomised to either the lower-dose combination group or the salbutamol-alone group but the small numbers (n=83) meant no conclusions could be drawn “in this important subpopulation”.

Read more in NEJM

Medical acronyms mystify patients

As more patients are accessing their electronic medical records, many fail to comprehend basic medical abbreviations and acronyms, a study has found.

Comprehension of common abbreviations such as ‘HTN’ (hypertension) and ‘MI’ (myocardial infarction) remained below 40%, much lower than clinicians estimated, a survey conducted at three US hospitals found.

The survey of 60 patients found that most understood terms such as hrs (hours) and BP (blood pressure) but only two thirds knew what ED meant and only about one in four comprehended terms such as hx (history) and HF (heart failure).

Researchers at the Department of Biomedical Informatics, Columbia University, New York, said clinicians should not assume that patients will understand even the most basic medical abbreviations. Automated text programs that convert and spell out acronyms in notes may help overcome misunderstanding of some medical abbreviations, they suggested.

The findings are published in JAMA Network Open.