Asthma

SAN FRANCISCO -- Some children, even if they have only mild to moderate asthma, may not get full symptom control despite consistent inhaled corticosteroid use, researchers have found.

SAN FRANCISCO -- Obesity makes asthma not only more common but worse, researchers reported here.

SAN FRANCISCO -- Nebulized formoterol (Perforomist) appears to treat chronic obstructive pulmonary disease as effectively as the dry-powder formulation (Foradil), researchers said here.

WINSTON-SALEM, N.C. -- For patients with mild persistent asthma, treatment options appear to have widened, according to two randomized trials.

ROTTERDAM, The Netherlands -- Through age five, children born at full term but with a low birth weight were more likely to have respiratory symptoms, but not asthma, researchers here reported.

BOSTON -- The so-called Mediterranean diet -- high in fruits, vegetables, fish, and whole grains -- is associated with a 50% reduction in the risk of chronic obstructive pulmonary disease, according to researchers here.

NEW YORK -- World Trade Center rescue workers exposed to airborne debris in the aftermath of the Sept. 11, 2001, attacks are at an increased risk for pulmonary sarcoidosis or a related disorder, investigators here have found.

DETROIT -- Asthma symptom control for urban African-American teens appears to improve via an Internet-based program tailored for them specifically, researchers here found.

Nonadherence with asthma controller medication is a common problem that increases the risk of asthma-related hospitalizations and emergency department visits. Although strategies to improve adherence have often been unsuccessful, it is clear that engaging patients in asthma self-management is one of the keys.

abstract: Proper assessment of the child's readiness for extubation and preparation for extubation are essential to minimize the need for reintubation and to maximize the child's safety in the periextubation period. Readiness for extubation requires that the child have adequate respiratory drive, the ability to maintain a patent airway, adequate oxygenation, and ability to ventilate spontaneously. Respiratory drive can be assessed by decreasing the ventilator settings to a minimal level and observing the child's respiratory effort and respiration rate. Evidence of increased work of breathing, such as tachypnea, retractions, and nasal flaring, suggests that the child may not be ready for extubation. If stridor and respiratory distress develop after the endotracheal tube is removed, nebulized racemic epinephrine is often quite effective; in addition, intravenous corticosteroids should be administered for 24 hours to help decrease the edema more quickly. (J Respir Dis. 2007;28(5):203-207)

A 33-year-old woman with a history of severe asthma requiring multiple intubations was brought to the emergency department. She had completed a 14-day course of prednisone 3 days earlier. Since then, she had had increasing dyspnea that acutely worsened after she used her albuterol nebulizer that morning. Her other asthma medications were theophylline and fluticasone. Her history included one episode of bilateral pneumothoraces secondary to barotrauma, which required chest tube insertion.

A 38-year-old woman with a history of injection drug use presented with progressive pain in the left arm and neck and fever (temperature, up to 38.8°C [102°F]) of 9 days' duration. Physical findings included subcutaneous crepitus, erythema, and swelling of the left arm, chest, and neck. White blood cell count was 27,000/µL with 91% neutrophils. Chest radiographs showed gas in the subcutaneous and soft tissue of the neck, arm, and chest . Necrotizing fasciitis was suspected.

A 38-year-old woman with a history of injection drug use presented with progressive pain in the left arm and neck and fever.

ABSTRACT: Patients who experience an acute myocardial infarction (MI) are at very high risk for recurrent cardiovascular events. Both site-supervised and home-based cardiac rehabilitation programs can effectively reduce all-cause and cardiovascular mortality. Start risk factor reduction as soon as possible; pharmacotherapy is best initiated while patients are still in the hospital. All patients who have had an MI should receive aspirin, an angiotensin-converting enzyme inhibitor, and a ß-blocker, unless these agents are contraindicated or are not tolerated. Prescribe aggressive lipid-lowering therapy to bring patients' low-density lipoprotein cholesterol levels to below 70 mg/dL. For smokers, quitting is the single most important change they can make to reduce future risk of MI.

Obesity is a well-known risk factor for many diseases. Now it looks like asthma can be added to the list. A meta-analysis that was conducted by Beuther and Sutherland indicated that being overweight is associated with a 50% increase in the incidence of asthma. The risk applies to both men and women.

Phytobezoars commonly develop in the distal small bowel, where the lumen is narrow. Prevalence is higher after partial gastric resection.

ROCHESTER, Minn. -- Asthma care remains focused primarily on the short-term chase of acute exacerbations rather than long-term control, researchers here said.

NEW YORK -- Eating too much bacon and sausage may increase the risk of chronic obstructive pulmonary disease, found researchers here.

NEW YORK -- Children with Helicobacter pylori infection have reduced risks of asthma and allergy, researchers here reported.

SEUOL, Korea -- The average body mass index in a group of children with otitis media with effusion was about 35% higher than among those with no history of ear infection, found researchers here.

DUBLIN -- Ireland's national ban on smoking in the workplace, including bars and restaurants, dramatically improved conditions for pub workers.

abstract: Subcutaneous allergen immunotherapy is clearly beneficial in the treatment of select patients with allergic rhinitis or asthma. However, this therapy is underused, partly because it requires administration in a medical facility. Sublingual immunotherapy (SLIT) may be a promising alternative; it appears to be associated with fewer adverse effects, which suggests that it might be administered at home. Currently, there is no FDA-approved formulation for SLIT in the United States. However, allergists are showing increased interest in this therapy, and an approved formulation may be available in the near future. A number of studies have shown the clinical efficacy of SLIT, but many questions remain unanswered, including the effective dose, optimal treatment schedules, and overall duration of treatment. (J Respir Dis. 2007;28(4):162-168)

A pruritic rash around the elbows; a soft, doughy papule; a slightlytender nodule with a keratotic core-do you recognize the disorderspictured here?

A middle-aged man hospitalized for intensive pulmonary toilet and topical and systemic treatment of a refractory skin disorder. Cough and moderate dyspnea with even mild exertion. Complains of scaling, uncomfortable dermopathy that he finds deeply cosmetically disfiguring and emotionally distressing.

LONDON -- On the eastern Mediterranean island of Crete, where olive oil is the primary source of fat, children with allergic rhinitis are uncommon, found a British team.

SOUTHAMPTON, England -- The research focus in asthma should shift back to conventional T-cells and away from the newly discovered invariant natural killer cells, according to investigators here.

DENVER, April 2 -- The occurrence rate of asthma increases by 50% in adults who are overweight or obese, according to a small meta-analysis.

A 65-year-old woman seeks evaluation of a tender, pruritic patchy rash on the trunk and extremities, as well as tender lips. Her symptoms began after she started taking a new NSAID for osteoarthritis. She has no known drug allergies and has not changed any other medications. The photographs were taken 2 days apart.

Allergic disorders are becoming more common. For example, about 20% of Americans have allergic rhinitis, which accounts for more than 10 million office visits each year. Most of these visits are to primary care clinicians.

UTRECHT, The Netherlands -- Lifeguards, swimming instructors, and other pool rats are likely to wind up with respiratory symptoms, according to researchers here.