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Solving a Respiratory Riddle X-ray


November 2005

by Natalie Gutierrez

It can affect anyone, from the very young to the elderly.

It can present itself in different forms, sometimes as a bacterium and sometimes as a virus.

It can seize the lungs suddenly, or spoil them slowly.

And it kills more people in hospital intensive care units in the United States each year than heart attacks.

What is it?

The answer is
pneumonia.



With the flu season fast approaching, people should be aware that pneumonia, a serious infection of the lungs, can result from complications of the flu or other upper-respiratory illnesses. According to the American Lung Association, pneumonia and influenza together rank as the seventh leading cause of death in the United States. Pneumonia consistently accounts for the majority of deaths.

A team of Health Science Center researchers is working to reverse that deadly trend. Eric Mortensen, M.D., assistant professor of medicine, and Marcos Restrepo, M.D., assistant professor in the division of pulmonary diseases and critical care medicine and the division of infectious diseases, are the authors of a pneumonia study published in The American Journal of Medicine in 2004. The article details a three-year-long investigation Drs. Mortensen and Restrepo and their colleagues conducted at University Hospital and the Audie L. Murphy Division of the South Texas Veterans Health Care System (VA) of more than 400 patients, ages 18 to 105, with pneumonia. Through the study, the team of researchers demonstrated that guidelines for the treatment of patients with community-acquired pneumonia, set by the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS), are the most effective in preventing death among patients hospitalized with this condition. They were among the first in the nation to conduct a study that specifically looked at guideline-consistent therapy.

Dr. Mortensen, who also is a researcher at the VA, said that although the rates of death from pneumonia dropped with the introduction of penicillin in 1942, they later stabilized and gradually increased.

"Because of that increase, numerous societies, including the IDSA and the ATS, developed clinical practice guidelines for the management of pneumonia," Dr. Mortensen said. "There were many questions about whether or not these practice guidelines would be effective, and limited evidence supported the IDSA and ATS recommendations. Our study, however, helped prove that they were indeed effective."

An important first step in effective IDSA and ATS treatment is that the patient receives at least one dose of antibiotics tailored to that patientís needs within the first four to eight hours after the patient is admitted to the hospital. The study showed that the death rate among patients who received this particular therapy was 6.2 percent compared to 21.7 percent in those who did not receive it.

Antonio Anzueto, M.D., professor of medicine in the division of pulmonary diseases and critical care medicine, is taking the investigation to the next level. He is leading a study at the Health Science Center and the VA that focuses on the treatment of patients with severe lung disease that can occur as a complication of pneumonia. The study is funded by the National Heart, Lung, and Blood Institute (NHLBI) for $500,000 over six years.

"The information we gather from this study, combined with what Drs. Mortensenís and Restrepoís investigation found, will allow us to further identify factors that will result in better treatment for pneumonia patients," he said.

Dr. Anzueto serves on a joint IDSA and ATS panel of experts charged with establishing further guidelines for the management of patients with community-acquired pneumonia. These new guidelines will be released in 2006.

Thanks to the work of talented Health Science Center researchers, future questions about the treatment of pneumonia patients will be answered and the diseaseís capacity to kill will be diminished.


Best in Texas

The Health Science Center is one of only two centers in Texas designated by the National Institutes of Health (NIH) to study acute respiratory distress syndrome (ARDS), a common complication of severe pneumonia that can cause permanent lung damage or death. The National Heart, Lung, and Blood Institute (NHLBI) of the NIH is funding the research.



Pneumonia & Flu

  • Season begins in late December and continues through late March.

  • Early fall is the best time to obtain pneumonia and flu vaccines.



    Who is most at risk?

  • The elderly, the very young, and those with underlying health problems such as chronic obstructive pulmonary disease (COPD), diabetes, congestive heart failure, sickle-cell anemia and those with other immune-suppressing diseases such as AIDS

  • Patients undergoing cancer therapy or organ transplantation are also vulnerable



    Treatment

    Viral pneumonia usually heals on its own. Treatment with antibiotics can cure bacterial pneumonia. A pneumococcal vaccine also is available and may protect against pneumonia caused by the pneumococcus bacterium.



    Who should get vaccinated?

    People ages 65 and those considered at high risk are advised to receive the pneumonia vaccine. The influenza vaccine is also recommended, as pneumonia can present itself as a complication of the flu.

    Source: American Lung Association

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