Asthma

The patient is a 4-year-old boy who hasbeen coughing persistently for the past 2months. The mother reports that aboutthe time the coughing began, the childhad a “cold” with nasal congestion andfever. These symptoms resolved, but acough ensued. The mother tried usingover-the-counter medications, includingcough suppressants, but the cough hasnot abated. It occurs during the day andat night. It is disrupting the child’s sleep,and the teachers at his day-care centerare concerned that he may be infectingother children.

During the past 3 decades, the prevalence of asthma andallergies in children has increased steadily. Today, about 5million American children have asthma, which is the leadingcause of absence from school. The editors and authors ofthis textbook-who are recognized authorities in theirfields-discuss recent advances in the field of allergy andimmunology and tailor this new information to the specialneeds of children. Children’s immune systems are in theprocess of development; this offers special opportunities forprevention and intervention. Presented here is detailedguidance in the diagnosis and management of immunologicdiseases, upper airway allergies, asthma, food allergies, allergicskin and eye diseases, and drug allergies. Differentialdiagnoses, approaches to evaluation, environmental triggers,and both established and emerging treatments are alladdressed. The latest immune-directed therapies are discussedin depth. Photographs, graphs, tables, and figuresappear throughout the text.

Theophylline has numerouswell-documented and clinicallysignificant drug interactions.Several diseases alsoaffect theophylline clearance.Here, I provide examples of drug anddisease interactions that are most relevantto office practice.

Q:Which patients with chronic respiratory disorders are good candidatesfor pulmonary rehabilitation? When is it a better option than surgery?

Chronic obstructive pulmonary disease(COPD) is the fourth leadingcause of chronic morbidity and mortalityin the United States.1 Its prevalenceand impact are increasing,and the World Bank/World HealthOrganization has projected that it willrank fifth in 2020 as a global burdenof disease.2,3 The economic and publichealth impact of COPD is staggering,because this chronic conditionrequires long-term care, frequentoffice visits, and use ofemergency department and hospitalservices. Thus, there is a pressingneed to discover new therapies thatcontrol symptoms and prevent diseaseprogression.

Q:Is there a role for inhaled corticosteroids in chronic obstructivepulmonary disease (COPD)?

SAN DIEGO -- Feline allergies' nine lives may be up. A fluffy white cat named Joshua and brethren would have allergic tabby-lovers, long starved of feline companionship, believe the day of the litter box is just ,950 away. Some allergists are skeptical. Other are taking a wait-and-sneeze approach

PHILADELPHIA -- Asthma mortality rates are declining worldwide, largely due to increased use of inhaled corticosteroids to manage the disease. That was the conclusion of an international group of researchers, who presented data on world trends at a 2006 meeting here.

HOUSTON -- Cromolyn, an old-line asthma and allergy drug, has shown a marked effect on the progress of pancreatic cancer - at least in mice.

GENEVA, Switzerland -- Rhinoviruses appeared to reach out beyond the upper respiratory tract to cause progressive respiratory and graft dysfunction that killed two of 11 lung transplant recipients, reported researchers here.

GENEVA, Switzerland -- Rhinoviruses appeared to reach out beyond the upper respiratory tract to cause progressive respiratory and graft dysfunction that killed two of 11 lung transplant recipients, reported researchers here.

The goals of therapy in chronic obstructive pulmonary disease are to ameliorate symptoms, improve daily function, preserve lung function, identify and reduce exacerbations and, if possible, decrease mortality. A comprehensiveapproach that includes prevention, early identification, and pharmacotherapy-and oxygen therapy, pulmonary rehabilitation, and/or surgery when appropriate-can optimize patient outcomes.

We describe a rare case in which chest pain and subcutaneous emphysema developed while the patient was undergoing routine dental extractions under local anesthesia and inhaled nitrous oxide. The patient was found to have extensive pneumomediastinum on a CT scan of the chest. The patient received supportive care and 24-hour high-flow oxygen (100%) and was discharged the next day without any residual symptoms. At a 10-day follow-up visit, neck and chest radiographs revealed no further subcutaneous emphysema.

ABSTRACT: Age-related changes that affect drug distribution, such as increased total body fat, decreased muscle mass, and decreased total body water, necessitate reduction in the dosage of water- and lipid-soluble agents. Because creatinine clearance declines with age, the dosage of agents that are excreted primarily by the kidney must also be lowered to prevent toxicity. Examples include aminoglycosides, fluoroquinolones, penicillins, procainamide, lithium, angiotensin-converting enzyme inhibitors, and digoxin. A good rule of thumb to follow until creatinine clearance can be calculated is to reduce the total dose by half in frail elderly persons or in those with established renal disease. Anticholinergic agents should be used with caution because they are associated with urinary retention, heart block, constipation, dry mouth, blurred vision, sedation, and acute or chronic confusion in elderly patients.

Inhalers that are used infrequently can dry out and become clogged, resulting in wasted medication. A simple overnight soak solves this problem.

Increasing evidence demonstrates that adolescents with asthma are at greater risk for anxiety and depression. However, few studies have investigated the association of psychological disorders with asthma symptoms, an important factor in evaluating asthma treatment. Now the results of a large population-based study of adolescents with asthma confirm that anxiety and depression are highly associated with increased asthma symptoms.

Abstract: Because of the impact of allergen exposure on asthma control, all patients with asthma should be evaluated for allergic sensitization. Such patients can be referred to an allergist for evaluation, or radioallergosorbent tests can be ordered by the primary care provider. The major groups of aeroallergens that can trigger asthma attacks include furred-pet, dust mite, cockroach, rodent, mold, and pollen allergens. When assessing a patient's exposure history, remember that furred-pet allergens are found not just in the home, but in other settings, such as schools, and these allergens are passively transferred from one environment to another. Allergen avoidance measures are essential to the management of asthma in sensitized patients and can significantly improve asthma control. First-line dust mite control measures include installing allergen-proof mattress and pillow encasements, washing all bedding every 1 to 2 weeks in hot water, removing stuffed toys, vacuuming and dusting regularly, and reducing indoor relative humidity. (J Respir Dis. 2006;27(12):511-526)

The association between asthma and pneumococcal disease has been suspected by many clinicians; however, formal investigations confirming an increased risk of pneumococcal disease in patients with asthma are rare.

For years, a 46-year-old African American woman had had progressive weight gain (despite a low-calorie diet), fatigue, and severe muscle cramps. On examination, Mandeep Hundal, MD, Rashid Khan, MD, Rajeev Garg, MD, and Niraj Mehta, MD, of the University of Texas Health Science Center at Houston, noted symmetrically distributed fatty lumps in the patient's neck, axillary and mammary regions, and proximal segments of the arms and legs. These findings are characteristic of Madelung disease, which is also known as multiple symmetric lipomatosis (MSL) or Launois-Bensaude syndrome.

PHILADELPHIA -- Asthma mortality rates are declining worldwide, largely due to increased use of inhaled corticosteroids to better manage the disease, according to a report from an international group of asthma researchers.

LOS ANGELES -- Children and teenagers who smoke have an increased risk of developing asthma within the next few years, especially if they were exposed during gestation to maternal smoking, researchers here found.

PHILADELPHIA -- With the first generic version of a nasal corticosteroid approved this year, more can be expected, according to a presentation here.

PHILADELPHIA -- Teens with asthma are more likely to be depressed and to smoke than their non-asthmatic peers, according to a preliminary analysis of CDC survey data.

PHILADELPHIA -- Corticosteroid medications are not without the risks of serious side effects, but there are ways to avoid or minimize them.

PHILADELPHIA -- Seasonal asthma exacerbations among children requiring hospitalizations don't seem to correlate with seasonal allergen prevalence, suggesting that other factors may be at work.

PHILADELPHIA -- Allergic reactions are among the most common side effects of complementary and alternative therapies, researchers reported here, but that doesn't stop patients with allergies from using them.

PHILADELPHIA -- When inhaled corticosteroids don't adequately control a patient's asthma, as often happens, the choice of the next-best add-on therapy is open to debate.

LOS ANGELES -- Patients with asthma and chronic obstructive pulmonary disease (COPD) receive only half the care that they should, according to a national sample.

PHILADELPHIA -- For patients with allergies and asthma, home sweet home could be masking a festering stew of molds, dust mites, noxious gases, building debris, and other unhealthy substances, suggested speakers at a symposium here.

PHILADELPHIA -- Rodent allergies, particularly sensitivity to mouse allergens, are common among inner city children, and may be the primary triggers for moderate-to-severe asthma, reported researchers here.