The Danish National Database for Asthma

AIM OF THE DATABASE: Asthma is the most prevalent chronic disease in children, adolescents, and young adults. In Denmark (with a population of 5.6 million citizens), >400,000 persons are prescribed antiasthmatic medication annually. However, undiagnosed cases, dubious diagnoses, and poor asthma management are probably common. The Danish National Database for Asthma (DNDA) was established in 2015. The aim of the DNDA was to collect the data on all patients treated for asthma in Denmark and to monitor asthma occurrence, the quality of diagnosis, and management. STUDY POPULATION: Persons above the age of 6 years, with a specific focus on 6–44 years, are included. The DNDA links three existing nationwide registries of administrative records in the Danish health care system: the National Patient Register, the National Health Insurance Services Register, and the National Prescription Registry. For each year, the inclusion criteria are a second purchase of asthma prescription medicine within a 2-year period (National Prescription Registry) or a diagnosis of asthma (National Patient Register). Patients with chronic obstructive pulmonary disease are excluded, but smokers are not excluded. DESCRIPTIVE DATA: A total of 366,471 prevalent patients with asthma have been identified (year 2014 – as a preliminary test search). This number is in agreement with the estimates of ~400,000 inhabitants that are available for patients with possible asthma in Denmark. Data encompass the following quality indicators: annual asthma control visits and pharmacological therapy. MAIN VARIABLES: The variables included are spirometry, as well as tools for diagnosis (including allergy testing), smoking status, height, weight, and acute hospital admissions and unscheduled visits. CONCLUSION: DNDA is available from January 1, 2016

Antibiotic treatment adequacy and death among patients with Pseudomonas aeruginosa airway infection

OBJECTIVE:The effect of antibiotics on survival in patients with pulmonary Pseudomonas aeruginosa is controversial. The aim of this study is to i) determine the prevalence of adequate antibiotic treatment of P. aeruginosa in an unselected group of adult non-cystic fibrosis patients and ii) to assess the overall mortality in study patients treated with adequate vs. non-adequate antibiotics. METHODS:Prospective, observational study of all adult patients with culture verified P. aeruginosa from 1 January 2010-31 December 2012 in Region Zealand, Denmark. Patients with cystic fibrosis were excluded. Adequate therapy was defined as any antibiotic treatment including at least one antipseudomonal beta-lactam for a duration of at least 10 days. Furthermore, P. aeruginosa had to be tested susceptible to the given antipseudomonal drug and treatment had to be approved by senior clinician to fulfil the adequate-criteria. RESULTS:A total of 250 patients were identified with pulmonary P. aeruginosa. The vast majority (80%) were treated with non-adequate antibiotic therapy. All-cause mortality rate after 12 months was 49% in adequate treatment group vs. 52% in non-adequate treatment group. Cox regression analysis adjusted for age, gender, bacteraemia, comorbidities and bronchiectasis showed no significant difference in mortality between treatment groups (adequate vs. non-adequate: hazard ratio 0.95, 95% CI 0.59-1.52, P = 0.82). CONCLUSION:Adequate antipseudomonal therapy was only provided in a minority of patients with pulmonary P. aeruginosa. Adequate therapy did not independently predict a favourable outcome. New research initiatives are needed to improve the prognosis of this vulnerable group of patients

Circulating Tumor DNA Monitoring Reveals Molecular Progression before Radiologic Progression in a Real-life Cohort of Patients with Advanced Non-small Cell Lung Cancer

Purpose: The clinical potential of liquid biopsy in patients with advancedcancer is real-time monitoring for early detection of treatment failure.Our study aimed to investigate the clinical validity of circulating tumorDNA (ctDNA) treatment monitoring in a real-life cohort of patients withadvanced non–small cell lung cancer (NSCLC).Experimental Design: Patients with advanced or noncurative locallyadvanced NSCLC were prospectively included in an exploratory study(NCT03512847). Selected cancer-specific mutations were measured inplasma by standard or uniquely designed droplet digital PCR assays beforeevery treatment cycle during first-line treatment until progressive disease(PD). Correlation between an increase in ctDNA (= molecular progres-sion) and radiologic PD was investigated, defined as lead time, and thecorresponding numbers of likely futile treatment cycles were determined.Utility of ctDNA measurements in clarifying the results of nonconclusiveradiologic evaluation scans was evaluated.Results: Cancer-specific mutations and longitudinal plasma sampling werepresent in 132 of 150 patients. ctDNA was detectable in 88 (67%) of132 patients treated by respectively chemotherapy (n = 41), immunotherapy(n = 43), or combination treatment (n = 4). In 66 (90%) of 73 patients ex-periencing PD, a ctDNA increase was observed with a median lead time of1.5 months before radiologic PD. Overall, 119 (33%) of 365 treatment cy-cles were administered after molecular progression. In addition, ctDNAmeasurements could clarify the results in 38 (79%) of 48 nonconclusiveradiologic evaluations.Conclusions: ctDNA monitoring leads to earlier detection of treatmentfailure, and clarifies the majority of nonconclusive radiologic evaluations,giving the potential of sparing patients from likely futile treatments andneedless adverse events.Significance: Treatment monitoring by ctDNA has the clinical potentialto reveal PD before radiologic evaluation and consequently spare patientswith advanced cancer from likely ineffective, costly cancer treatments andadverse events

Transthoracic ultrasound-guided biopsy in the hands of chest physicians – a stepwise approach

Background: The evaluation of patients with lung lesions is challenging. The nature of the lesion can be determined by pathological evaluation of biopsies. The pulmonologists will be met by increasing demands with regard to biopsy techniques including ultrasound-guided transthoracic needle biopsy (US-TTNB).Objective: The aim of this paper is to present the pulmonologist to a systematic step-by-step guide for performing US-TTNB and to assess the evidence for this approach. Method/results: Indications, contraindications and a step-by-step guide for the techniques used when performing US-TTNB are presented, and major complications and handling of these are described. Conclusion: US-TTNB performed by pulmonologists is a safe and feasible procedure