title: Early warning and prevention of pneumonia in acute leukemia by patient education, spirometry, and positive expiratory pressure: A randomized controlled trial.
abstract: Long-lasting neutropenia associated with acute myeloid leukemia (AML) and its treatment gives rise to a high risk of pneumonia. The use of broad-spectrum antibiotic prophylaxis during outpatient management has not completely protected patients against admission due to infections and neutropenic fever, emphasizing the need to approach infection protection with complementary efforts. In a randomized controlled design, we examined the applicability of patient-performed daily spirometry [forced expiratory volume in one second (FEV1)] as an early warning tool and explored the effectiveness of positive expiratory pressure (PEP) in preventing pneumonia among 80 AML patients. Twenty-five incidences of pneumonia were detected among 23 patients (6 interventions, 17 controls), giving a prevalence of 28.75% during 5420 days of observation. We found a significant difference in incidence between intervention versus control group (2.17 per 1000 days vs. 6.52 per 1000 days, P = 0.021, respectively). A cross point at 80-76% of the personal FEV1 reference value showed high sensitivity and specificity on pneumonia development. Our data demonstrate the feasibility of educating AML patients in their continuous daily measurement of FEV1 and use of PEP. Daily measures of FEV1 may be an important early warning tool for assessment of pulmonary deterioration during critical phases of neutropenia. We suggest that strategic patient education in the use of spirometry and PEP should be part of standard of care for AML patients undergoing induction chemotherapy.
authors.affiliation: University Hospitals Centre for Health Research (UCSF), Copenhagen, Denmark.
authors.forename: Tom
authors.initials: T
authors.lastname: Møller
authors.affiliation: Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Denmark.
authors.forename: Claus
authors.initials: C
authors.lastname: Moser
authors.affiliation: University Hospitals Centre for Health Research (UCSF), Copenhagen, Denmark.
authors.forename: Lis
authors.initials: L
authors.lastname: Adamsen
authors.affiliation: University Hospitals Centre for Health Research (UCSF), Copenhagen, Denmark.
authors.forename: Grith
authors.initials: G
authors.lastname: Rugaard
authors.affiliation: University Hospitals Centre for Health Research (UCSF), Copenhagen, Denmark.
authors.forename: Mary
authors.initials: M
authors.lastname: Jarden
authors.affiliation: Department of Haematology, Copenhagen University Hospital, Herlev, Copenhagen, Denmark.
authors.forename: Tina S
authors.initials: TS
authors.lastname: Bøtcher
authors.affiliation: University Hospitals Centre for Health Research (UCSF), Copenhagen, Denmark.
authors.forename: Liza
authors.initials: L
authors.lastname: Wiedenbein
authors.affiliation: Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Kjeldsen
mesh_terms: D019072:Antibiotic Prophylaxis; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000097:blood / Q000150:complications* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000097:blood / Q000150:complications* / Q000453:epidemiology; D010353:Patient Education as Topic / Q000379:methods; D011014:Pneumonia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D011175:Positive-Pressure Respiration / Q000379:methods*; D013147:Spirometry; D016896:Treatment Outcome