A survey of positive airway pressure therapy preparedness and outcomes following Hurricane Irma in patients with obstructive sleep apnea.

STUDY OBJECTIVES: Clinical benefit from positive pressure therapy is dependent on treatment adherence. Extreme weather events, such as floods, hurricanes, and tornadoes, can contribute to nonadherence by electricity loss and mandatory evacuation. We aimed to evaluate the concerns and behaviors of regular positive airway pressure users surrounding the extreme weather event Hurricane Irma. METHODS: A questionnaire on positive pressure concerns surrounding Hurricane Irma was completed by 117 patients with pre-hurricane objectively confirmed treatment adherence as defined by Medicare. Responses were tabulated to identify concerns and behavior in preparation for and after Hurricane Irma. Cloud-based monitoring, available on 50 (43%) cases, was used to determine the effect of self-reported electricity loss on treatment adherence before and after the storm. Quantitative use data pre- and post-Hurricane Irma was compared by t test with P < .05 considered statistically significant. RESULTS: Post-hurricane 78 (67%) patients were unable to use treatment with mean duration of 4.3 days. Of these, snoring, choking, and sleepiness were reported in 64%, 19%, and 42%, respectively. Loss of electricity was identified as the cause of missed treatment in 71 patients. In those with cloud monitoring, mean 14-day pre- and post-hurricane use differed by 8 minutes (P =.056). Cloud-monitored cases with loss of electricity had a decline in mean use of 33 minutes for the first 7 days post-hurricane. There was a trend towards increased use post-hurricane in those that retained electricity. Many patients expressed dissatisfaction with the availability of preparedness guidelines. CONCLUSIONS: Although common, loss of electricity was not the sole disruptor of positive pressure use after extreme weather events. Regular users of positive airway pressure experience both disruption in patterns of use and concerns regarding preparedness for extreme weather events.

Rheumatoid Arthritis-Associated Interstitial Lung Disease: Current Concepts.

PURPOSE OF REVIEW: Among the many extra-articular complications of rheumatoid arthritis (RA), interstitial lung disease (ILD) contributes significantly to morbidity and mortality. Prevalence estimates for RA-ILD vary widely depending on the specific clinical, radiographic, and functional criteria used to establish the diagnosis. A key unresolved issue is whether early, subclinical forms of RA-ILD represent a precursor to end stage, fibrotic lung disease. Based on uncertainties surrounding the natural history of RA-ILD, incomplete understanding of underlying disease pathogenesis, and lack of controlled clinical trials, evidence-based therapeutic strategies remain largely undefined. RECENT FINDINGS: Correlative clinico-epidemiological studies have identified key risk factors for disease progression. Complementing these findings, the identification of specific molecular and serological markers of RA-ILD has improved our understanding of disease pathogenesis and established the foundation for predictive biomarker profiling. Experience from case series and cohort studies suggests that newer biological agents such as rituximab may be viable treatment options. RA-ILD continues to have a major impact on "disease intrinsic" morbidity and mortality. Increased understanding of disease pathogenesis and the natural history of subclinical RA-ILD will promote the development of more refined therapeutic strategies.