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2020 JAMA
doi: 10.1001/jama.2020.20884pmid: 33289809
This Arts and Medicine feature reviews a memoir by a pseudonymous UK neuropsychologist who, through creative telling of case histories, questions the boundaries between doctor and patient, brain and mind, language and thought, and well and unwell.
2020 JAMA
doi: 10.1001/jama.2020.21717pmid: 33206137
This Medical News article examines how studying the characteristics of long-term pancreatic cancer survivors might improve treatment and boost survival for others who have the disease
Datta, S. Deblina; Talwar, Amish; Lee, James T.
2020 JAMA
doi: 10.1001/jama.2020.22717pmid: 33206133
This Viewpoint uses clinical observations of the natural course of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection to propose 3 phases of illness: acute infection (what people commonly refer to with the COVID-19 designation); postacute hyperinflammatory illness (referred to clinically as multisystem inflammatory syndrome); and late inflammatory sequelae, manifest as enduring cardiac, neurological, and psychological symptoms.
Vahia, Ipsit V.; Jeste, Dilip V.; Reynolds, Charles F.
2020 JAMA
doi: 10.1001/jama.2020.21753pmid: 33216114
This Viewpoint summarizes evidence suggesting that, counter to expectation, older adults as a group may be more resilient to the anxiety, depression, and stress-related mental health disorders characteristic of younger populations during the COVID-19 pandemic.
2020 JAMA
doi: 10.1001/jama.2020.21332pmid: 33136157
This Viewpoint discusses possible parallels between the distortion in sensory information and faulty monitoring of ideas characteristic of some patients with neurodegenerative diseases (dementia with Lewy bodies and Capgras syndrome, frontotemporal dementia) and the creation and maintenance of false conspiratorial beliefs about the COVID-19 pandemic in healthy populations that has hobbled an effective national response in the US.
Wang, Emily A.; Western, Bruce; Berwick, Donald M.
2020 JAMA
doi: 10.1001/jama.2020.22109pmid: 33196762
This Viewpoint summarizes a National Academy of Sciences, Engineering, and Medicine (NASEM) consensus panel report recommending ways to reduce populations in prisons and jails as a means to mitigate SARS-CoV-2 transmission and the roles clinicians, health systems, and insurers can play in in process.
Agarwal, Anubha; Yancy, Clyde W.; Huffman, Mark D.
2020 JAMA
doi: 10.1001/jama.2020.21395pmid: 33211084
This Viewpoint proposes that a polypill combination of a β-blocker, renin angiotensin inhibitor, mineralocorticoid receptor antagonist, and sodium-glucose cotransporter 2 inhibitor might be the most efficient way to deliver guideline-directed HFrEF therapy, and proposes a research roadmap to design and evaluate the pill and implementation strategies for getting it to patients.
2020 JAMA
doi: 10.1001/jama.2020.23077pmid: 33289824
In this narrative medicine essay, a senior faculty investigator describes common reactions to her visible disability and calls for recruitment of a diverse workforce into academic medicine’s workforce and leadership positions to normalize physical differences immaterial to the pursuit of outstanding science and patient care.
Lovinsky-Desir, Stephanie; O’Connor, George T.
2020 JAMA
doi: 10.1001/jama.2020.16895pmid: 33270088
Research in the 1960s and 1970s revealed increasing prevalence of asthma in the US and internationally, the importance of airway inflammation in asthma, and the role of indoor aeroallergens as causal or aggravating environmental factors in many patients with asthma. The introduction of inhaled corticosteroid (ICS) treatment for asthma in the 1970s provided an effective approach to long-term pharmacologic therapy. In 1991, the National Heart, Lung, and Blood Institute sponsored the development of the National Asthma Education and Prevention Program (NAEPP) Guidelines for the Diagnosis and Management of Asthma,1 offering clinicians a synthesis of new and evolving treatments and a practical approach to management. These guidelines, periodically updated since then, have had a major effect on clinical practice, and in this issue of JAMA, an update of the NAEPP guidelines summarizes new recommendations for long-term management of adolescents and adults with asthma.2 One change with important implications for patients, clinicians, pharmacists, and payers is the recommendation for use of ICSs on an as-needed basis guided by symptoms for patients with mild or moderate persistent asthma. For mild persistent asthma, the updated guideline recommends (conditional recommendation) either a regular daily ICS with an as-needed inhaled short-acting β2-agonist (SABA) or use of both an inhaled SABA and an ICS as needed when symptoms occur. For moderate persistent asthma, the update recommends (strong recommendation) a daily maintenance regimen of an ICS combined in a single inhaler with formoterol (a long-acting β2-agonist [LABA] with rapid onset of action) plus extra doses of the combination ICS-formoterol therapy as needed for asthma symptoms. This approach for treating persistent asthma is referred to as single maintenance and reliever therapy (SMART). These recommendations, based on evidence from randomized clinical trials,3,4 are a major shift from previous versions of the NAEPP guidelines, which recommended an ICS, sometimes in combination with a LABA, only as a regular daily regimen, supplemented by an as-needed SABA for symptom relief. Challenges of the previously recommended approach are inconsistent patient adherence to an ICS with no immediate effect on symptoms and lack of rapid titration of the ICS dose according to current symptom frequency. An essential point regarding the SMART approach to moderate persistent asthma is that the LABA in the combination inhaler must be formoterol because of its rapid onset combined with long duration of action. LABAs with slower onset are not suitable for SMART. A crucial practical consideration related to the implementation of both an as-needed ICS for mild persistent asthma and SMART for more severe asthma requiring daily ICS-LABA therapy is that at present, the medication plans of many US payers cover only 1 inhaler per month for ICS or ICS-LABA combination inhalers. This limitation must be eliminated, without any requirements for individual prior approval, for these recommended treatment approaches to be widely adopted. Two open-label, multicenter randomized clinical trials of intermittent ICS treatment for asthma have been published since the October 2018 end date of the literature review on which this NAEPP guidelines update is based. The PRACTICAL trial,5 which included 890 patients with intermittent to moderate persistent asthma, and the Novel START trial,6 which included 675 patients with intermittent to mild persistent asthma, both demonstrated that as-needed use of inhaled budesonide-formoterol was associated with a lower rate of severe asthma exacerbations than daily maintenance budesonide plus an as-needed SABA. These trials support the concept of intermittent, as-needed use of ICSs for mild asthma, but they also lend support to the updated Global Initiative for Asthma (GINA) 2020 guidelines,7 which differ from the new NAEPP guidelines in recommending as-needed ICS-formoterol therapy as preferred step 1 and step 2 treatment for intermittent and mild persistent asthma. The GINA approach has the advantage of simplicity, relying on ICS-formoterol therapy for all steps of treatment, and will need to be considered by the NAEPP expert panel in future updates. The new NAEPP guidelines make important recommendations regarding the use of inhaled long-acting muscarinic antagonists (LAMAs) for long-term asthma control. While recommending against LAMA therapy for patients at risk of glaucoma or urinary retention, the expert panel advocates this therapy as an add-on to medium to high-dose ICS-LABA therapy when asthma remains uncontrolled by the latter (conditional recommendation, moderate certainty of evidence). Randomized, double-blind, multicenter trials published subsequent to the expert panel’s literature review support this recommendation, indicating that add-on LAMA therapy in this situation leads to modestly improved lung function8-10 and may lead to a modest reduction in exacerbations.8 Although the evidence supports the expert panel’s conditional recommendation, further research on the effect of LAMA therapy for asthma not controlled with ICS-LABA therapy on patient-centered outcomes would be needed for this to become a strong recommendation. Another update to the guidelines is the recommended use of fractional exhaled nitric oxide (FeNO), a noninvasive biomarker of eosinophilic airway inflammation in allergic asthma.11 The expert panel recommends the use of FeNO as an adjunct to asthma diagnosis (conditional recommendation) and management (conditional recommendation), with a strong recommendation against the use of FeNO alone to monitor disease activity. The emphasis of the recommendation is on the use of FeNO as part of a comprehensive management strategy together with other clinical parameters (symptoms, exacerbation frequency, spirometry) to monitor asthma control and adjust medications. It is not recommended that FeNO be used in isolation to monitor exacerbation severity or risk of future exacerbations. Since the completion of the expert panel review, 4 published randomized trials have examined the benefit of adding FeNO to guidelines-based management for asthma, with only 2 of the studies demonstrating benefit in reducing asthma medication use12,13 and treatment costs13 in selected subgroups. For example, the daily ICS dose was significantly lowered in patients who were managed based on FeNO in addition to symptoms and guideline-based management, but only among participants with low FeNO (<25 ppb) in 1 study involving 179 patients12 and those with moderate asthma in a second study involving 176 patients.13 Another study with 301 patients examined the addition of a type 2 inflammatory biomarker profile that included FeNO as well as blood eosinophil and periostin levels. The authors reported improvement in the ability to step down asthma treatment among patients who were monitored using FeNO, but only when analysis was restricted to the per-protocol group and not in the intention-to-treat analysis.14 In other words, participants’ lack of adherence to the treatment regimen influenced the outcomes of the study and highlights the importance of patient adherence to treatment plans to titrate medications. Also, evidence regarding the utility of FeNO in management of childhood and adolescent asthma is lacking, with pediatric studies that were included in the guidelines review15 and subsequently16 demonstrating no added benefit in reducing exacerbations in children. Additional research regarding the specific patient subgroups who benefit most from adding FeNO monitoring to other clinical assessments is needed to inform future guidelines updates. As pointed out by the expert panel, the routine use of FeNO measurement in the clinical setting poses a number of challenges. For example, currently there are limited data on clinically significant threshold values to inform adjustments in therapy.11,17 In addition, the interpretation of results is complicated by falsely high and low values related to obesity, recent ingestion of specific foods, exercise, and allergic diseases other than asthma. The added burden of cost of specialized equipment, training to administer the test, and increased clinic visit duration may make FeNO a more practical option in the subspecialty care setting than in the primary care setting, where multiple health issues are often addressed at each visit. However, diverting more asthma management to specialists could have unintended consequences of increasing health disparities, especially in communities where marginalized populations have reduced access to subspecialty care.18 Considering the limitations of the supporting evidence and the barriers to implementation, the advisability of widespread adoption of FeNO measurements in clinical practice remains uncertain. The updated NAEPP guidelines include 4 conditional recommendations regarding allergen reduction measures to improve asthma control. The expert panel recommends the use of allergen reduction in sensitized and exposed individuals, multicomponent strategies to achieve allergen reduction, and pest management strategies for patients with cockroach or rodent allergy and asthma. The panel recommends against reliance on single-component strategies to achieve allergen reduction. These recommendations suggest that a single remediation intervention targeting 1 or more allergens will generally not confer significant protection against allergen-induced asthma exacerbations. It is likely that certain exceptions exist, such as finding a new home for a household pet to which a patient is allergic, although the expert panel did not comment on scenarios such as this. Rather, a multifaceted approach to allergen remediation is necessary to offer significant control of asthma symptoms. This set of guidelines may be another example that points in favor of specialty care for management of asthma. To adhere to these allergen reduction guidelines, clinicians should confirm that a patient with asthma is both sensitized and exposed to each particular allergen, which requires access to either allergen skin-prick testing or serum-specific immunoglobulin E assays in the clinical setting. Additionally, the time required to counsel patients regarding specific approaches to reduce allergen exposures may require specific visits dedicated to asthma management that are not feasible in the primary care setting. The expert panel offers a conditional recommendation in favor of the use of subcutaneous immunotherapy (SCIT) and a conditional recommendation against the use of sublingual immunotherapy (SLIT). SCIT, usually performed by allergy specialists, may reduce allergic airway responses to inhaled allergens; however, the evidence that SCIT reduces asthma exacerbations was insufficient in both children and adults to achieve more than a conditional recommendation. The greatest benefit of SCIT appears to be in the improvement of asthma symptoms. Since the completion of the expert panel review, a recently published study of 693 patients demonstrated potential benefit of house dust mite SLIT in reducing the time to asthma exacerbation among participants with recent exacerbations.19 However, to date, the US Food and Drug Administration has not approved SLIT for the management of asthma, and the expert panel, finding only “trivial benefit” for critical asthma outcomes, recommends against its use. The expert panel also gives a conditional recommendation against the use of bronchial thermoplasty for managing severe asthma, advising that if considered at all, it should be restricted to highly selected patients with shared decision-making and in the context of a clinical trial or research registry. For SCIT, SLIT, and bronchial thermoplasty,20 evidence continues to accumulate and may ultimately support stronger recommendations regarding these therapies in future guideline updates. This welcome update of the NAEPP asthma guidelines has several limitations noted by the authors. The update included only 6 topics, leaving out important areas such as the use of monoclonal antibody–based biologics to treat severe asthma. This update does not address asthma diagnosis and management in children younger than 12 years. The evidence base reviewed by the expert panel did not include reports published after October 2018. In addition, there are a number of distinct asthma phenotypes that likely have different underlying pathophysiologic mechanisms,21 and these diverse phenotypic groups may benefit from different treatment strategies. This guideline update focuses largely on allergic asthma, with special attention given to FeNO measurement, allergen reduction, and immunotherapy. Nonallergic phenotypes of asthma receive little attention, likely because of limited clinical trials that address specific management strategies for noneosinophilic asthma phenotypes (eg, exercise-induced, neutrophilic). Future guidelines will hopefully be able to address other mechanisms relevant to the pathogenesis and control of asthma. The updated NAEPP guidelines in this issue of JAMA summarize new recommendations for the long-term management of adolescents and adults with asthma and should be helpful for clinicians who provide care for patients with asthma in the US and around the world. It is based on an intensive review of the medical literature, assimilated into important recommendations, noting those that are conditional or strong. It is an important contribution to the evolving strategies for long-term asthma management. Back to top Article Information Corresponding Author: George T. O’Connor, MD, MS, Pulmonary Center, Boston University School of Medicine, Boston, MA 02118 (goconnor@bu.edu). Published Online: December 3, 2020. doi:10.1001/jama.2020.16895 Conflict of Interest Disclosures: None reported. References 1. Guidelines for the diagnosis and management of asthma: National Heart, Lung, and Blood Institute: National Asthma Education Program: expert panel report. J Allergy Clin Immunol. 1991;88(3 pt 2):425-534.PubMedGoogle Scholar 2. Cloutier MM, Dixon AE, Krishnan JA, Lemanske RF Jr, Pace W, Schatz M. Managing asthma in adolescents and adults: 2020 asthma guideline update from the National Asthma Education and Prevention Program. JAMA. Published online December 3, 2020. doi:10.1001/jama.2020.21974Google Scholar 3. Papi A, Canonica GW, Maestrelli P, et al; BEST Study Group. Rescue use of beclomethasone and albuterol in a single inhaler for mild asthma. N Engl J Med. 2007;356(20):2040-2052. doi:10.1056/NEJMoa063861PubMedGoogle ScholarCrossref 4. Sobieraj DM, Weeda ER, Nguyen E, et al. Association of inhaled corticosteroids and long-acting β-agonists as controller and quick relief therapy with exacerbations and symptom control in persistent asthma: a systematic review and meta-analysis. JAMA. 2018;319(14):1485-1496. doi:10.1001/jama.2018.2769PubMedGoogle ScholarCrossref 5. Hardy J, Baggott C, Fingleton J, et al; PRACTICAL Study Team. Budesonide-formoterol reliever therapy versus maintenance budesonide plus terbutaline reliever therapy in adults with mild to moderate asthma (PRACTICAL): a 52-week, open-label, multicentre, superiority, randomised controlled trial. Lancet. 2019;394(10202):919-928. doi:10.1016/S0140-6736(19)31948-8PubMedGoogle ScholarCrossref 6. Beasley R, Holliday M, Reddel HK, et al; Novel START Study Team. Controlled trial of budesonide-formoterol as needed for mild asthma. N Engl J Med. 2019;380(21):2020-2030. doi:10.1056/NEJMoa1901963PubMedGoogle ScholarCrossref 7. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention. Updated 2020. Accessed October 30, 2020. https://ginasthma.org/wp-content/uploads/2020/06/GINA-2020-report_20_06_04-1-wms.pdf 8. Virchow JC, Kuna P, Paggiaro P, et al. Single inhaler extrafine triple therapy in uncontrolled asthma (TRIMARAN and TRIGGER): two double-blind, parallel-group, randomised, controlled phase 3 trials. Lancet. 2019;394(10210):1737-1749. doi:10.1016/S0140-6736(19)32215-9PubMedGoogle ScholarCrossref 9. Lee LA, Bailes Z, Barnes N, et al. Efficacy and safety of once-daily single-inhaler triple therapy (FF/UMEC/VI) versus FF/VI in patients with inadequately controlled asthma (CAPTAIN): a double-blind, randomised, phase 3A trial. Lancet Respir Med. Published online September 9, 2020. doi:10.1016/S2213-2600(20)30389-1PubMedGoogle Scholar 10. Kerstjens HAM, Maspero J, Chapman KR, et al; IRIDIUM Trial Investigators. Once-daily, single-inhaler mometasone-indacaterol-glycopyrronium versus mometasone-indacaterol or twice-daily fluticasone-salmeterol in patients with inadequately controlled asthma (IRIDIUM): a randomised, double-blind, controlled phase 3 study. Lancet Respir Med. 2020;8(10):1000-1012. doi:10.1016/S2213-2600(20)30190-9PubMedGoogle ScholarCrossref 11. Dweik RA, Boggs PB, Erzurum SC, et al; American Thoracic Society Committee on Interpretation of Exhaled Nitric Oxide Levels (FeNO) for Clinical Applications. An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FeNO) for clinical applications. Am J Respir Crit Care Med. 2011;184(5):602-615. doi:10.1164/rccm.9120-11STPubMedGoogle ScholarCrossref 12. Boer S, Honkoop PJ, Loijmans RJB, et al. Personalised exhaled nitric oxygen fraction (FENO)-driven asthma management in primary care: a FENO subgroup analysis of the ACCURATE trial. ERJ Open Res. 2020;6(3):00351-2019. doi:10.1183/23120541.00351-2019PubMedGoogle Scholar 13. Truong-Thanh T, Vo-Thi-Kim A, Vu-Minh T, Truong-Viet D, Tran-Van H, Duong-Quy S. The beneficial role of FeNO in association with GINA guidelines for titration of inhaled corticosteroids in adult asthma: a randomized study. Adv Med Sci. 2020;65(2):244-251. doi:10.1016/j.advms.2020.03.001PubMedGoogle ScholarCrossref 14. Heaney LG, Busby J, Hanratty CE, et al; Investigators for the MRC Refractory Asthma Stratification Programme. Composite type-2 biomarker strategy versus a symptom-risk-based algorithm to adjust corticosteroid dose in patients with severe asthma: a multicentre, single-blind, parallel group, randomised controlled trial. Lancet Respir Med. Published online September 7, 2020. doi:10.1016/S2213-2600(20)30397-0PubMedGoogle Scholar 15. Szefler SJ, Mitchell H, Sorkness CA, et al. Management of asthma based on exhaled nitric oxide in addition to guideline-based treatment for inner-city adolescents and young adults: a randomised controlled trial. Lancet. 2008;372(9643):1065-1072. doi:10.1016/S0140-6736(08)61448-8PubMedGoogle ScholarCrossref 16. Morphew T, Shin HW, Marchese S, Pires-Barracosa N, Galant SP. Phenotypes favoring fractional exhaled nitric oxide discordance vs guideline-based uncontrolled asthma. Ann Allergy Asthma Immunol. 2019;123(2):193-200. doi:10.1016/j.anai.2019.05.008PubMedGoogle ScholarCrossref 17. See KC, Christiani DC. Normal values and thresholds for the clinical interpretation of exhaled nitric oxide levels in the US general population: results from the National Health and Nutrition Examination Survey 2007-2010. Chest. 2013;143(1):107-116. doi:10.1378/chest.12-0416PubMedGoogle ScholarCrossref 18. Turner A, Ricketts T, Leslie LK. Comparison of number and geographic distribution of pediatric subspecialists and patient proximity to specialized care in the US between 2003 and 2019. JAMA Pediatr. 2020;174(9):852-860. doi:10.1001/jamapediatrics.2020.1124PubMedGoogle ScholarCrossref 19. Tanaka A, Tohda Y, Okamiya K, Azuma R, Terada I, Adachi M. Efficacy and safety of HDM SLIT tablet in Japanese adults with allergic asthma. J Allergy Clin Immunol Pract. 2020;8(2):710-720. doi:10.1016/j.jaip.2019.09.002PubMedGoogle ScholarCrossref 20. Goorsenberg AWM, d’Hooghe JNS, Srikanthan K, et al; TASMA Research Group. Bronchial thermoplasty induced airway smooth muscle reduction and clinical response in severe asthma: the TASMA randomized trial. Am J Respir Crit Care Med. 2020. doi:10.1164/rccm.201911-2298OCPubMedGoogle Scholar 21. Pavord ID, Beasley R, Agusti A, et al. After asthma: redefining airways diseases. Lancet. 2018;391(10118):350-400. doi:10.1016/S0140-6736(17)30879-6PubMedGoogle ScholarCrossref
Nicholls, Stephen J.; Lincoff, A. Michael; Garcia, Michelle; Bash, Dianna; Ballantyne, Christie M.; Barter, Philip J.; Davidson, Michael H.; Kastelein, John J. P.; Koenig, Wolfgang; McGuire, Darren K.; Mozaffarian, Dariush; Ridker, Paul M; Ray, Kausik K.; Katona, Brian G.; Himmelmann, Anders; Loss, Larrye E.; Rensfeldt, Martin; Lundström, Torbjörn; Agrawal, Rahul; Menon, Venu; Wolski, Kathy; Nissen, Steven E.
2020 JAMA
doi: 10.1001/jama.2020.22258pmid: 33190147
Key PointsQuestionIn statin-treated patients with high cardiovascular risk, high triglycerides, and low HDL cholesterol levels, does adding a carboxylic acid formulation of omega-3 fatty acids (eicosapentaenoic acid and docosahexaenoic acid) to background therapy improve cardiovascular outcomes? FindingsIn this randomized clinical trial of 13 078 patients that was stopped early, daily supplementation with omega-3 fatty acids, compared with corn oil, resulted in no significant difference in a composite outcome of major adverse cardiovascular events (hazard ratio, 0.99). MeaningThese findings do not support use of this omega-3 fatty acid formulation to reduce major adverse cardiovascular events in patients with high cardiovascular risk.
Wilson, Andrew M.; Clark, Allan B.; Cahn, Tony; Chilvers, Edwin R.; Fraser, William; Hammond, Matthew; Livermore, David M.; Maher, Toby M.; Parfrey, Helen; Swart, Ann Marie; Stirling, Susan; Thickett, David R.; Whyte, Moira; ,
2020 JAMA
doi: 10.1001/jama.2020.22960pmid: 33289822
Key PointsQuestionWhat is the clinical efficacy of co-trimoxazole (trimethoprim-sulfamethoxazole) in idiopathic pulmonary fibrosis (IPF) in terms of time to death (all causes), lung transplant, or first nonelective hospital admission? FindingsIn this randomized clinical trial, which included 343 patients with moderate or severe IPF, the incidence of the composite outcome among those treated with oral co-trimoxazole, 960 mg twice daily, vs those treated with placebo was 0.45 vs 0.38 per person-year after a median follow-up of 1.02 years; the hazard ratio was not statistically significant. MeaningCo-trimoxazole compared with placebo did not improve a composite clinical outcome among patients with moderate or severe IPF.
Lenze, Eric J.; Mattar, Caline; Zorumski, Charles F.; Stevens, Angela; Schweiger, Julie; Nicol, Ginger E.; Miller, J. Philip; Yang, Lei; Yingling, Michael; Avidan, Michael S.; Reiersen, Angela M.
2020 JAMA
doi: 10.1001/jama.2020.22760pmid: 33180097
Key PointsQuestionDoes fluvoxamine, a selective serotonin reuptake inhibitor and σ-1 receptor agonist, prevent clinical deterioration in outpatients with acute coronavirus disease 2019 (COVID-19)? FindingsIn this randomized trial that included 152 adult outpatients with confirmed COVID-19 and symptom onset within 7 days, clinical deterioration occurred in 0 patients treated with fluvoxamine vs 6 (8.3%) patients treated with placebo over 15 days, a difference that was statistically significant. MeaningIn this preliminary study, adult outpatients with symptomatic COVID-19 treated with fluvoxamine, compared with placebo, had a lower likelihood of clinical deterioration over 15 days; however, determination of clinical efficacy would require larger randomized trials with more definitive outcome measures.
Cloutier, Michelle M.; Dixon, Anne E.; Krishnan, Jerry A.; Lemanske, Robert F.; Pace, Wilson; Schatz, Michael
2020 JAMA
doi: 10.1001/jama.2020.21974pmid: 33270095
This guideline summarizes updated recommendations for management of asthma in adolescents and adults, focusing on evidence for use of inhaled corticosteroids (ICSs), add-on long-acting muscarinic antagonists (LAMAs), fractional exhaled nitric oxide (FeNO) testing, indoor allergen mitigation, immunotherapy, and evidence against use of bronchial thermoplasty.
Uyeki, Timothy M.; Santoli, Jeanne; Jernigan, Daniel B.
2020 JAMA
doi: 10.1001/jama.2020.21849pmid: 33136115
This JAMA Insights Clinical Update discusses the importance of established influenza prevention and control measures, including influenza vaccination and antiviral treatment, as the Global North enters its first influenza season in the COVID-19 pandemic.
Tucker, Bryan M.; Pirkle, James L.; Raghavan, Rajeev
2020 JAMA
doi: 10.1001/jama.2020.18400pmid: 33125046
A 63-year-old woman with type 2 diabetes was referred for refractory hypomagnesemia (1.4 mg/dL; low normal, 1.8 mg/dL). Her medications included liraglutide, metformin, lisinopril, and magnesium oxide (400 mg twice daily). A recent hemoglobin A1c level was 10.8%, and her urinary magnesium was 117 mg. How do you interpret the urine level, and what would you do next?
Chan, Noel C.; Li, Karen; Hirsh, Jack
2020 JAMA
doi: 10.1001/jama.2020.21905pmid: 33125030
This study describes changes in portable oximeter–measured peripheral oxygen saturation (Spo2 or O2sat) in older adults before, during, and after wearing a 3-layer plane-shaped disposable nonmedical face mask widely used to protect against COVID-19.
Natalucci, Giancarlo; Latal, Bea; Koller, Brigitte; Rüegger, Christoph; Sick, Beate; Held, Leonhard; Fauchère, Jean-Claude
2020 JAMA
doi: 10.1001/jama.2020.19395pmid: 33289818
This study reports 5-year neurodevelopmental outcomes for Swiss children born before 32 weeks’ gestation and randomized at birth to receive early high-dose recombinant human erythropoietin (rhEpo) vs placebo.
2020 JAMA
doi: 10.1001/jama.2020.21869pmid: 33136143
This JAMA Patient Page describes the groups of people who are at high risk of complications from influenza infection, how to reduce risk through vaccination, and steps high-risk people should take if they develop influenza symptoms.