News in Brief: Dramatic drop in bacterial pneumonia; Tighter glycaemic control improves lung function recovery in CF;  Vitamin D in moderation protective against respiratory infection

Wednesday, 7 Apr 2021

Lockdown has led to dramatic drop in bacterial pneumonia 

Social distancing measures introduced to stave off COVID-19 infection have dramatically reduced paediatric thoracic empyema cases in Australia, report Melbourne clinicians.

Respiratory and infectious disease specialists at The Royal Children’s Hospital Melbourne say the state’s prolonged period of social distancing, spanning the usual peak period for bacterial respiratory infection, has led to reduced paediatric hospital activity with reduced admissions, presentations for respiratory conditions and detection of other viruses.

In a letter to the editor of ERJ Open Research clinicians from the largest paediatric hospital in the state say they observed a ‘significant reduction’ in empyema admissions to match the large reductions in influenza, respiratory syncytial virus, bronchiolitis and viral pneumonia cases reported by others during pandemic-related lockdown.

Last year the hospital recorded 5 empyema cases down from 27 cases in each of the two years previous.

Bronchiolitis admissions fell to just 97 cases in 2020 down from 768 in 2019.

The profound reduction in paediatric respiratory infections are unlikely to be due to changes in hospital presentation, they add, given appendicitis presentations remained relatively unchanged last year compared to pre-COVID.

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Tighter glycaemic control improves lung function recovery in cystic fibrosis after acute exacerbations

Poor glycaemic control in patients with cystic fibrosis related diabetes (CFRD) may predict poorer lung function recovery following hospitalisation for pulmonary exacerbation, according to new research from Monash Health.

Clinicians involved in the study say the findings suggest tighter glucose control may help maximise recovery during exacerbations.

The findings are based on the CGM (continuous glucose monitoring) readings of 20 CF patients – 13 of who had CFRD – taken over six weeks from first admission to hospital for pulmonary exacerbation (PEx).

The mean of both CGM indices were highest during the first week of pulmonary exacerbation and continued to decline over the first four weeks where they then plateaued, investigators observed.

factors predictive of maximum attained lung function recovery change over the six-week period were %T>7.8, mean glucose, HbA1c and preadmission ppFEV1 change from baseline – factors that were independent of a diagnosis of CFRD.

More clinical trials are required to evaluate the merits of intensive glycemic control in CFRD during PEx, they said.

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Vitamin D in moderation protective against respiratory infection

Vitamin D in  daily, moderate doses is protective against acute respiratory infection, a large meta analysis reveals.

An international team of investigators, including from Australia and New Zealand, report updated findings on a large meta analysis of 43 randomised and placebo controlled studies involving nearly 49,000 participants.

Despite significant heterogeneity between trials investigators say the study shows ‘a small but significant’ protective effect of vitamin D supplementation on the risk of having one or more ARIs compared with placebo.

The vitamin D dosing regimen of most benefit was daily and used standard doses (400–1000 IU) for up to 12 months with participants in this group demonstrating a 42% reduction in infection risk compared to placebo,

Whether the relevance of these findings can be applied to COVID-19 however is not known, say investigators and requires further investigation.

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