American Thoracic Society news tips for March Journal Second Issue

New drugs needed to halt global growth of Tuberculosis

A call for further public-private sector cooperation to develop new drugs to deal with the major, growing worldwide problem of tuberculosis (TB) infection is highlighted by two experts from the Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, in the second of two March issues of the American Journal of Respiratory and Critical Care Medicine. They note that TB worldwide continues to kill young and middle-aged adults faster than any other disease besides acquired immune deficiency syndrome (AIDS). Today, they point out, the disease is a greater problem than it was at the beginning of the 20th century. Estimates show the emergence of 8 million new cases of TB during 1997, with 2 million dying from the disease. Major areas affected by the infectious disease include sub-Saharan Africa and South Asia–locales where the AIDS virus has spread rapidly. In addition, the illness is a serious problem throughout the Russian Federation which has seen the emergence of TB drug-resistant strains.

Although there have been no major new drugs for the disease in 30 years, over the past decade the capacity to undertake large-scale clinical trials has been restored in the U.S. and Canada through the CDC’s TB Trials Consortium. Also, the National Institutes of Health supports the TB Research Unit which conducts trials largely outside the U.S. Finally, the World Health Organization recently launched a Global Alliance for TB Drug Development. Although many significant obstacles remain, the experts believe the prospect for the development of new and more effective drugs for TB are much greater now than at any time in the past several decades.

Does slower beat of nasal cilia lead to more respiratory infections in older persons?

Knowing that older persons are especially susceptible to lower respiratory tract infections, these investigators studied cilia movement–the rhythmic action of tiny hair-like structures–in the nasal passages. The sweeping action of cilia help to move mucus and to defend the airway against inhaled microbes. The Hong Kong investigators point out the efficacy of mucociliary clearance depends on the function of healthily beating respiratory cilia which must beat in a coordinated fashion and in the same direction. In their research with 90 persons who ranged in age from 11 to 90, they found that those over age 40 had a significantly lower ciliary beat frequency than their younger counterparts. They also saw an increasing occurrence of ultra-structural defects in the older person’s cilia, according to their research study published in the second of two March issues of the American Journal of Respiratory and Critical Care Medicine. These findings, they believe, could explain the frequent occurrence of respiratory infections in the elderly.

Short, broad skull formation associated with higher rates of apnea in white persons

A congenital malformation called brachycephaly that makes the skull abnormally short and broad was associated with higher rates of apnea-hypopnea in white persons, but not in African- Americans, according to a study in the second of two March issues of the American Journal of Respiratory and Critical Care Medicine. The investigators examined the association of head and facial form with the apnea-hypopnea index in 364 white individuals and 165 African-Americans. The adult subjects of both races were over age 25 and had a body mass index of less than 32–a level that excluded the markedly obese. Being seriously overweight puts people at increased risk for sleep apnea–a problem which involves brief periods (10 seconds or more) of breathing cessation during sleep. The researchers collected data on cranial and facial dimensions using anthropometric calipers, took measurements of body mass index and neck circumference, and assessed the patients’ apnea-hypopnea index using a overnight sleep monitor. Among those patients who had 15 apneic episodes per hour of sleep, they found 74 white persons who had a tendency toward a brachycephalic head form with a shorter, wider cranial base which resulted in a wider, shorter face type. They did not find a similar relationship in African-Americans.

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