Acupuncture for dyspnea on exertion in chronic obstructive pulmonary disease: no blindness.

Abstract

should not be used to modify clinical practice. However, although mortality is objective and important, most patients withCAPdonotdie.BecausenewinterventionsforCAPare likely to result in only small changes in mortality, large sample sizes are required to detect clinically important changes. Therefore, it has been suggested that mortality is an insensitive measure of quality of care or treatment failure in CAP. 3 In our article, 1 we clearly pointed out that our study was not powered to detect a survival difference. Nevertheless, we found that only 4 of 200 patients (2%) in the 3-step group and 2 of 201 patients (1%) in the usual care group died. Importantly, no patient died during the 30-day follow-upperiodafterdischarge.However,itshouldbenoted that patients receiving usual care were more likely to experience adverse drug reactions, mainly phlebitis, probably related to the longer duration of intravenous antibiotic therapy in this group. Webelievethatapplyingthe3-stepcriticalpathway(early mobilizationanduseofobjectivecriteriaforswitchingtooral antibiotics and for deciding on hospital discharge) to the selected population analyzed is safe and effective and may allowcostsavings.Inthisregard,themostrecentInfectiousDiseasesSocietyofAmerica/AmericanThoracicSocietyConsensus