Top 5 Papers (Part 2): Challenging Asthma Diagnoses, Natriuretic Guided Therapy for Heart Failure, and Opioid Prescribing Patterns
Each year, the Canadian Society for Internal Medicine (CSIM) Annual Meeting features a presentation of the “Top 5 Papers” in internal medicine. From the papers that had been discussed on The Rounds Table between November 2016 and October 2017, we selected 5 that we felt were particularly influential and presented them as the “Top 5 Papers” this year at CSIM. This week’s episode is the second part of the live recording of Kieran and Amol’s talk. A summary of these Top 5 papers will be published in the CJGIM as a collaboration with CSIM.
In clinical practice, asthma management is not always straightforward. Although it is a chronic disease, the stability of the diagnosis and the rate of spontaneous remission is unknown. Additionally, in practice, asthma is often diagnosed clinically without formalized spirometry testing. Amol covers a prospective multi-centre cohort study re-evaluating the diagnosis of asthma in adults with a pre-existing physician diagnosis to determine if the diagnosis could be ruled out in some cases and asthma medications safety stopped.
Next, Kieran covers a trial which examines the effect of natriuretic peptide guided therapy on hospitalization or cardiovascular mortality in patients with heart failure with reduced ejection fraction.
Finally, Amol leads the discussion on a study examining opioid prescribing patterns of physicians that work in the Emergency Department. Opioid abuse is a major public health problem in North America. One proposed driver in patients going on to long-term opioid therapy is initial over-prescription.
- Challenging Asthma Diagnoses: https://jamanetwork.com/journals/jama/article-abstract/2598265
- BNP and HFrEF: http://jamanetwork.com/journals/jama/article-abstract/2649188
- Opiods in the ED: http://www.nejm.org/doi/full/10.1056/NEJMsa1610524?query=featured_home
The Rounds Table Theme Music by Brendan Quinn, Creative Director and Composer, Vapor RMW