A Total Eclipse: Treatment of Status Epilepticus and Aclidinium Bromide in COPD

Freddy Frost, research fellow in cystic fibrosis in Liverpool, and Alex Pickard, trainee in acute and emergency medicine in South London, are back on The Rounds Table this week. They are covering treatment of paediatric convulsive status epilepticus and the effect of aclidinium bromide on cardiovascular events and exacerbations in patients with chronic obstructive pulmonary disease (COPD) who are high-risk.

Convulsive status epilepticus in the paediatric population is managed using the Advanced Paediatric Life Support (APLS) algorithm.  After two doses of benzodiazepines, in the APLS algorithm the next step is second-line treatment.  There is a gap in high-quality literature to support second-line agents and these medications have differences in terms of ease of administration, preparation, and drug interactions.  Alex summarizes the EcLiPSE trial, comparing the efficacy and safety of levetiracetam to phenytoin for second-line treatment for status epilepticus in the paediatric population.

Long-acting muscarinic antagonists (LAMA’s) are recommended by major guidelines for bronchodilation in patients with COPD.  Recent literature has suggested that with short-acting muscarinic antagonists or LAMA’s, there may be an increased risk of cardiovascular events.  Next, Freddy shares the ASCENT-COPD trial which compares aclidinium bromide to placebo and assesses for major adverse cardiovascular outcomes in patients with moderate to severe COPD and significant cardiovascular disease.

Finally, the Good Stuff segment.  Freddy highlights the story of a young patient post-lung transplant for cystic fibrosis who developed a Mycobacterium abscessus skin and lung infection who failed systemic therapies and was eventually successfully treated with bacteriophages.

Like what you hear?  Rate us on iTunes!  Chat with us on Twitter at @roundstable and tweet at Freddy Frost @Freddy_Frost1 and Alex Pickard @apickard99.

Interested in helping us evaluate our podcast episodes? We’re currently recruiting a panel of residents to serve as regular reviewers for the show. If you’re interested, email wkwong@qmed.ca.

The Papers

1. EcLiPSE trial: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30724-X/fulltext

2. ASCENT-COPD trial: https://www.ncbi.nlm.nih.gov/pubmed/31063575

Good Stuff

1. Engineered bacteriophages for treatment of a patient with disseminated drug-resistantMycobacterium abscessus: https://www.nature.com/articles/s41591-019-0437-z

Music Credits

The Rounds Table Theme Music by Brendan Quinn, Creative Director and Composer, Vapor RMW

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