Screening after sleep studies will reveal primary aldosteronism
People with both hypertension and obstructive sleep apnoea (OSA) should be routinely screened for primary aldosteronism (PA).
A prospective study of 85 patients referred for sleep studies found the proportion of the total cohort with likely PA was 2.4% and possible PA was 11.8%.
However among the hypertensive cohort, the prevalence of likely PA was 4.6% and possible PA was 23.2%. In participants with both OSA and hypertension, the prevalence of likely PA and possible PA was a similar 5% and 25%, respectively.
“There was a significant relationship between increasing aldosterone:renin ratio (ARR), even within the normal range, and the awake diastolic BP load. However, no relationship between aldosterone, rennin, or the ARR and OSA severity was identified,” the study said.
The researchers from Monash University said PA screening tests are substantially under-utilised in clinical practice however it should be considered at every opportunity, such as following a diagnostic sleep study.
Fibrinogen levels can predict COPD exacerbations
The rate of COPD exacerbations is highest among patients with the highest fibrinogen levels, according to an analysis from the IMPACT trial, which investigated FF/UMEC/VI triple therapy versus FF/VI and UMEC/VI therapy in patients with symptomatic COPD.
“The results from this study support the rationale for using fibrinogen levels as a predictive biomarker for clinical trial recruitment as it provides an indicator of patients at an increased risk of COPD exacerbations,” wrote study authors led by Dr Dave Singh, of the University of Manchester, in Respiratory Research.
Among more than 8,000 patients, the rates of moderate, moderate/severe, and severe exacerbations were higher in the highest versus the lowest fibrinogen quartile. The use of 3.5 g/L as a cutoff appeared effective, with the rate ratios for exacerbations significantly higher in those above the cutoff than those below.
“Importantly, findings from this study support the utility of fibrinogen as a predictive marker for exacerbations in clinical practice; aiding the identification of a subgroup of patients with COPD that are at a higher risk of experiencing exacerbations and would benefit from appropriate treatment to reduce future risk,” the authors wrote.
Vapers given six month deadline on legal purchases
Vapers have been reminded that from 1 October they will no longer be able to buy or import nicotine e-cigarettes or nicotine vaping products from overseas websites without a valid doctor’s prescription.
And since there are currently no approved nicotine e-cigarettes on the Australian Register of Therapeutic Goods (ARTG), this means medical practitioners will need to apply to the TGA for access to the unapproved product before they write a prescription for nicotine vaping products, according to the TGA.
Alternatively, after 1 October, doctors may provide vapers with a script for a three month (or less) supply of nicotine e-cigarettes if they intend to use the Personal Importation Scheme to buy the products from an overseas website.
The changes mean that apart from pharmacies dispensing nicotine e-cigarettes to patients with a prescription, it will be illegal for any other Australian retailers, including vape stores, to sell nicotine e-cigarettes or nicotine vaping products.
The TGA says the changes are being introduced because there has been a significant increase in vaping among young people in Australia, and to make the law applying to importation of nicotine e-cigarettes and nicotine vaping products consistent with existing state and territory laws regarding their sale.