Management of chronic obstructive pulmonary disease-A position statement of the South African Thoracic Society: 2019 update.

Objective To revise the South African guideline for the management of COPD based on emerging research that has informed updated recommendations. Key points Smoking is the major cause of COPD, HIV infection, exposure to biomass fuels and tuberculosis are important additional factors. Spirometry is important for the diagnosis of COPD. COPD is either undiagnosed or diagnosed too late, thus limiting the benefit of therapeutic interventions; performing spirometry in at-risk individuals will help to identify COPD early. COPD should be managed as a multisystem disease with attention to comorbidities, particularly cardiovascular disease. Primary and secondary prevention are the most cost-effective strategies in managing COPD. Smoking cessation as well as avoidance of other risk factors can prevent the development of COPD and retard disease progression. Bronchodilators [long-acting muscarinic antagonist (LAMA) or long-acting beta-2 agonists (LABA)] are the mainstay of pharmacotherapy, relieving dyspnoea, reducing acute exacerbations, reducing rate of disease progression and improving quality of life. Inhaled corticosteroids (ICS) are recommended in patients with frequent exacerbations and those with peripheral blood eosinophilia and have a synergistic effect with bronchodilators in improving lung function, quality of life and reducing exacerbation frequency. Oral corticosteroids are not recommended for maintenance treatment of COPD. A therapeutic trial of oral corticosteroids to distinguish corticosteroid responders from non-responders is not recommended. Acute exacerbations of COPD contribute significantly to health care costs, accelerates loss of lung function and increases mortality. A short course of oral corticosteroids (5 days) has been shown to be beneficial in acute exacerbations. Antibiotics are indicated during acute exacerbations associated with purulent sputum. Lifestyle modification, pulmonary rehabilitation (PR), pneumococcal vaccination and annual influenza vaccination are recommended for COPD patients

Critical care admission of South African (SA) surgical patients: Results of the SA Surgical Outcomes Study

Background. Appropriate critical care admissions are an important component of surgical care. However, there are few data describing postoperative critical care admission in resource-limited low- and middle-income countries.Objective. To describe the demographics, organ failures, organ support and outcomes of non-cardiac surgical patients admitted to critical care units in South Africa (SA).Methods. The SA Surgical Outcomes Study (SASOS) was a 7-day national, multicentre, prospective, observational cohort study of all patients ≥16 years of age undergoing inpatient non-cardiac surgery between 19 and 26 May 2014 at 50 government-funded hospitals. All patients admitted to critical care units during this study were included for analysis.Results. Of the 3 927 SASOS patients, 255 (6.5%) were admitted to critical care units; of these admissions, 144 (56.5%) were planned, and 111 (43.5%) unplanned. The incidence of confirmed or strongly suspected infection at the time of admission was 35.4%, with a significantly higher incidence in unplanned admissions (49.1 v. 24.8%, p<0.001). Unplanned admission cases were more frequently hypovolaemic, had septic shock, and required significantly more inotropic, ventilatory and renal support in the first 48 hours after admission. Overall mortality was 22.4%, with unplanned admissions having a significantly longer critical care length of stay and overall mortality (33.3 v. 13.9%, p<0.001).Conclusion. The outcome of patients admitted to public sector critical care units in SA is strongly associated with unplanned admissions. Adequate ‘high care-dependency units’ for postoperative care of elective surgical patients could potentially decrease the burden on critical care resources in SA by 23%. This study was registered on ClinicalTrials.gov (NCT02141867)

IgG subclasses in previously healthy adult patients with acute community-acquired pneumoma

No Abstract

Critical care admission of South African (SA) surgical patients : results of the SA surgical outcomes study

CITATION: Skinner, D. L., et al. 2017. Critical care admission of South African (SA) surgical patients : results of the SA surgical outcomes Study. South African Medical Journal, 107(5):411-419, doi:10.7196/SAMJ.2017.v107i5.11455.The original publication is available at http://www.samj.org.za/index.php/samjBackground. Appropriate critical care admissions are an important component of surgical care. However, there are few data describing postoperative critical care admission in resource-limited low- and middle-income countries. Objective. To describe the demographics, organ failures, organ support and outcomes of non-cardiac surgical patients admitted to critical care units in South Africa (SA). Methods. The SA Surgical Outcomes Study (SASOS) was a 7-day national, multicentre, prospective, observational cohort study of all patients ≥16 years of age undergoing inpatient non-cardiac surgery between 19 and 26 May 2014 at 50 government-funded hospitals. All patients admitted to critical care units during this study were included for analysis. Results. Of the 3 927 SASOS patients, 255 (6.5%) were admitted to critical care units; of these admissions, 144 (56.5%) were planned, and 111 (43.5%) unplanned. The incidence of confirmed or strongly suspected infection at the time of admission was 35.4%, with a significantly higher incidence in unplanned admissions (49.1 v. 24.8%, p<0.001). Unplanned admission cases were more frequently hypovolaemic, had septic shock, and required significantly more inotropic, ventilatory and renal support in the first 48 hours after admission. Overall mortality was 22.4%, with unplanned admissions having a significantly longer critical care length of stay and overall mortality (33.3 v. 13.9%, p<0.001). Conclusion. The outcome of patients admitted to public sector critical care units in SA is strongly associated with unplanned admissions. Adequate ‘high care-dependency units’ for postoperative care of elective surgical patients could potentially decrease the burden on critical care resources in SA by 23%. This study was registered on ClinicalTrials.gov (NCT02141867).http://www.samj.org.za/index.php/samj/article/view/11880Publisher's versio