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Cardiovascular Medicine - Aortic Disease
Beta blocker therapy for Marfan syndrome (November 2022)
Patients with Marfan syndrome (MFS) are treated with an angiotensin II receptor blocker (ARB) or beta blocker to reduce the risk of aortic aneurysm, but data comparing a beta blocker with no treatment for MFS are limited. The effects of beta blocker therapy versus control were estimated in an individual patient data meta-analysis that compared the effects of an ARB versus control (placebo or open control) with the effects of an ARB versus a beta blocker on the rate of change of aortic root dimension in patients with MFS.2 The indirect estimate of the effect of beta blocker therapy was similar to the direct effect of an ARB. For adults with MFS and aortic aneurysm, we recommend a beta blocker or ARB.
Cardiovascular Medicine - Arrhythmias
Motor vehicle crash risk in patients with syncope and other conditions (November 2022)
Studies of the risk of motor vehicle crash in patients with history of syncope have generally compared this risk with that in the general population. In a study that compared motor vehicle crash risk in over 9000 patients with "syncope and collapse" and over 34,000 patients visiting emergency departments with conditions other than syncope, the crash rates in the patient populations were similar and higher than that in the general population.3 As a practical matter, patients were diagnosed with "syncope and collapse," which is not the same as an established diagnosis of syncope. The study suggests that motor vehicle accidents are likely to be similarly increased among patients with acute illness of sufficient severity to cause them to seek emergency department evaluation.
Family Medicine - Adult General Internal Medicine
CDC updates opioid prescribing guidelines (November 2022)
The United States Centers for Disease Control and Prevention (CDC) has published a new guideline for prescribing opioids for acute, subacute, and chronic pain, updating their 2016 guideline. The guideline is intended for clinicians who prescribe opioids to outpatients >=18 years of age and does not apply to pain related to sickle cell disease, cancer, palliative care, or end of life care.4
Allergy and Immunology - Asthma and COPD
COVID-19 and asthma control in children (November 2022)
Initial data suggested that COVID-19 did not increase asthma morbidity in children, contrary to that expected for a viral respiratory infection. However, asthma control may have improved during the early waves of the pandemic due to an overall decrease in viral respiratory infections. A comparison of nearly 62,000 children with asthma from 108 health care systems in the United States from March 2020 through February 2021 found that a SARS CoV-2 polymerase chain reaction-positive test was associated with increased rates of emergency department visits, hospitalizations, and use of short-acting beta agonist and oral glucocorticoids in the six months following the positive test compared with those who tested negative.1 This reinforces the importance of patients continuing medications necessary to maintain optimal asthma control so as to better weather COVID-19 and other viral respiratory infections.
1. Chou CC, Morphew T, Ehwerhemuepha L, Galant SP. COVID-19 infection may trigger poor asthma control in children. J Allergy Clin Immunol Pract. 2022;10(7):1913. [Context Link]
2. Pitcher A, Spata E, Emberson J, et al Angiotensin receptor blockers and [beta] blockers in Marfan syndrome: An individual patient data meta-analysis of randomized trials. Lancet. 2022;400(10355):822. [Context Link]
3. Staples JA, Erdelyi S, Merchant K, et al Syncope and the risk of subsequent motor vehicle crash: A population-based retrospective cohort study. JAMA Intern Med. 2022;182(9):934. [Context Link]
4. Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC clinical practice guideline for prescribing opioids for pain - United States, 2022. MMWR Recomm Rep. 2022;71(3):1. [Context Link]
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