Asthma is a very prevalent disease in the United States, and the incidence is rising for a variety of reasons. Although progress has been made on several therapeutic fronts, adherence to asthma therapy, particularly controller medications, remains poor. This review of data from the past five years will focus on factors associated with nonadherence, barriers to adherence, factors associated with adherence, and finally strategies for improving. Communication between the health care provider and patient is paramount in improving adherence to medical therapy for asthma and thereby improving control of the disease.

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BackgroundThe volume-outcome relationship associated with intensive care unit (ICU) experience with managing acute myocardial infarction (AMI) remains inadequately understood.Methods and ResultsWithin a multicenter clinical ICU database, we identified patients with a primary ICU admission diagnosis of AMI between 2008 and 2010 to evaluate whether annual AMI volume of an individual ICU is associated with mortality, length-of-stay, or quality indicators. Patients were categorized into those treated in ICUs with low-annual-AMI volume (≤50th percentile, <2 AMI patients/month, n=569 patients) versus high-annual-AMI volume (≥90th percentile, ≥8 AMI patients/month, n=17 553 patients). Poisson regression and generalized estimating equation with negative binomial regression were used to calculate the relative risk (95% CI) for mortality and length-of-stay, respectively, associated with admission to a low-AMI-volume ICU. When compared with high-AMI-volume, patients admitted to low-AMI-volume ICUs had substantially more medical comorbidities, higher in-hospital mortality (11% versus 4%, P<0.001), longer hospitalizations (6.9±7.0 versus 5.0±5.0 days, P<0.001), and fewer evidence-based therapies for AMI (reperfusion therapy, antiplatelets, β-blockers, and statins). However, after adjustment for baseline patient characteristics, low-AMI-volume ICU was no longer an independent predictor of in-hospital mortality (relative risk 1.17 [0.87 to 1.56]) or hospital length-of-stay (relative risk 1.01 [0.94 to 1.08]). Similar findings were noted in secondary analyses of ICU mortality and ICU length-of-stay.ConclusionsAdmission to an ICU with lower annual AMI volume is associated with higher in-hospital mortality, longer hospitalization, and lower use of evidence-based therapies for AMI. However, the relationship between low-AMI-volume and outcomes is no longer present after accounting for the higher-risk medical comorbidities and clinical characteristics of patients admitted to these ICUs.

Middle-lobe torsion is a well documented but rare entity that typically occurs following surgery, characteristically after right-upper lobectomy. It has also been described in the setting of pleural effusion, trauma, and neoplasm. We present a case of spontaneous middle-lobe torsion, occurring in the absence of the above risk factors, with emphasis on radiographic and CT findings.

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