Asthma

Abstract: Allergic drug reactions are mediated by IgE. Other immunologic drug reactions are mediated by IgG and complement, T cells, systemic cytokine release, and mast cell activation. True drug allergies, which are IgE-mediated, account for less than 10% of all adverse drug reactions. IgE-mediated reactions are commonly seen with penicillins, but also occur with some other antibiotics, chemotherapeutic agents, therapeutic proteins, and neuromuscular blockers. They are often limited to urticaria but also include life-threatening anaphylaxis. Skin testing to identify patients who are allergic is available for many agents associated with IgE-mediated reactions. Protocols for desensitization permit the use of some culprit agents when indicated. (J Respir Dis. 2006;27(11):463-471)

Although the overall rates of asthma-related hospitalization and death are about 2.5 to 5 times higher among black than white patients, it has not been known whether hospital deaths also are increased in black patients with asthma exacerbations. Investigators from Johns Hopkins who studied this issue found there were no significant race differences in hospital deaths.

SALT LAKE CITY -- Smokers and ex-smokers treated with statins for cardiovascular disease had less of a decline in lung function than comparable patients not taking statin, researchers reported here.

SALT LAKE CITY -- Incorrect use of home nebulizers may contribute to the deaths of some asthma patients, researchers reported here.

DENVER -- The trivalent influenza vaccine appears to be safe in children between the ages of six and 23 months, according to researchers here who reviewed more than 69,000 vaccinations among more than 45,000 children.

SALT LAKE CIY -- A deficiency in the enzyme alpha-1 antitrypsin (A1AT) may help explain why some people exposed to the toxic dust from the collapse of the World Trade Center towers developed respiratory disease and others didn't.

DUNDEE, Scotland -- A smoking ban in enclosed places here had a quick effect on bar workers -- significant improvements in respiratory function and lower systemic inflammation.

LONDON -- The TNF-alpha inhibitor Remicade (infliximab) decreased the number of asthma exacerbations in a small clinical trial, but the drug had no significant effect on peak expiratory flow, the study's primary efficacy endpoint.

A pressurized metered-dose inhaler (MDI), the most common asthma-medication delivery system, does not indicate the quantity of medication remaining in the canister after use. Are patients with asthma using their MDIs beyond the indicated number of doses or, alternatively, disposing of them before they are empty? That is the question researchers investigated in a random sample of 500 respondents with asthma.

Although the cause of chronic cough can often be identified (with asthma and postnasal drip being 2 of the most common culprits), it sometimes eludes diagnosis. Bastian and associates studied a group of patients with idiopathic chronic cough that was diagnosed clinically as sensory neuropathic cough. They found that this type of cough responded well to the tricyclic antidepressant amitriptyline.

Abstract: Because of recent advances, more patients may potentially benefit from a variety of interventional bronchoscopic techniques. Nd:YAG laser phototherapy is the most widely used modality and is the treatment of choice for patients with endobronchial malignancies who have large-central airway obstruction. Cryotherapy may be superior to Nd:YAG phototherapy for more distal airways lesions because of the lower risk of airway perforation, but it may be suboptimal for bulky airways disease that requires quick relief of obstruction. Brachytherapy relieves symptoms, such as cough, dyspnea, and hemoptysis, in many patients who have locally invasive airway malignancies. Endobronchial ultrasonography appears to be a safe and sensitive method for staging lung cancer. In select patients with emphysema, a 1-way endobronchial valve can be used to reduce lung volumes. Bronchial thermoplasty is being studied as a potential treatment for asthma. (J Respir Dis. 2006;27(10):415-428)

As with any potential exposure, the initial approach should be to establish the patient's diagnosis before attempting to determine the effect of a potential exposure. The main differential diagnoses to consider for a patient who has cough and wheezing that may be associated with an exposure are asthma, chronic obstructive pulmonary disease, allergic rhinitis, and vocal cord dysfunction.

Abstract: There is solid evidence that a positive association exists between nasal allergy and acute or chronic sinusitis in both adults and children. Patients with perennial allergic rhinitis--especially those with significant sensitivity to molds and/or house dust mites--are particularly susceptible to acute sinusitis. It therefore seems reasonable to assume that controlling rhinitis by controlling allergens in the home environment will minimize recurrences of acute sinusitis. Conversely, many patients with chronic sinusitis also have nasal allergy. Thus, management of nasal allergy should be included in the treatment strategy for chronic sinusitis. (J Respir Dis. 2006; 27(10):435-440)

ABSTRACT: There is solid evidence that a positive association exists between nasal allergy and acute or chronic sinusitis in both adults and children. Patients with perennial allergic rhinitis--especially those with significant sensitivity to molds and/or house dust mites--are particularly susceptible to acute sinusitis. It therefore seems reasonable to assume that controlling rhinitis by controlling the home environment will minimize recurrences of acute sinusitis. Conversely, many patients with chronic sinusitis also have nasal allergy. Thus, management of nasal allergy should be included in the treatment strategy for chronic sinusitis.

If left untreated, sinusitis can cause significant physical symptoms and can negatively affect quality of life by substantially impairing the daily functioning of sufferers. For children, this can mean learning difficulties at school and for adults, a loss of efficiency at work.

Can early intervention with inhaled corticosteroids help prevent irreversible lung function decline in patients with asthma? Yes, according to results of the international Inhaled Steroid Treatment as Regular Therapy in Early Asthma (START) study.

Perhaps surprisingly, limited published data exist on the effects of smoking cessation on symptoms, lung function, and corticosteroid responsiveness in smokers who have asthma. However, in a prospective controlled study, Scottish researchers found that 6 weeks af-ter smoking cessation, patients with asthma had significant improvement in lung function and a decrease in sputum neutrophil count compared with patients who continued to smoke.

MUNICH -- A simple breath test accurately predicts which patients with a chronic cough will benefit from inhaled corticosteroid treatment, according to a study presented here.

ABERDEEN, Scotland -- Children whose mothers consume more foods containing vitamin E during pregnancy are less likely to develop wheeze or asthma by the age of five, according to researchers here.

This year, the American Academy of Allergy, Asthma, and Immunology (AAAAI) published guidelines for referring patients to an allergist/immunologist.1 The AAAAI's recommendations for patients with asthma were summarized in the July 2006 issue of

Abstract: Rhinosinusitis affects millions of persons annually and has a marked impact on quality of life and work productivity. Chronic rhinosinusitis (CRS) is characterized by symptoms that last at least 12 weeks. The history and physical examination should include a search for underlying conditions, such as allergic or nonallergic rhinitis and nasal polyposis. An evaluation of underlying immunodeficiency is warranted in certain patients, particularly those with severe or difficult-to-treat disease or other recurrent infections. When radiologic evaluation is indicated, coronal sinus CT scanning is the procedure of choice. While antibiotics are indicated for bacte- rial rhinosinusitis, intranasal corticosteroids represent the mainstay of treatment for CRS and are particularly useful when polyp disease is present. Nasal irrigation with a saline solution can be a very beneficial adjunctive therapy. Depending on coexisting conditions, additional treatments may include antihistamines, leukotriene modifiers, and immunotherapy. (J Respir Dis. 2006;27(9):372-379)

Pruritic eruptions on both arms of a 12-year-old who has played outdoors all summer; a rash on the hand of a teenage baseball player . . . might sports be responsible for these lesions?

Increased attention is being given to the potential use of bronchial thermoplasty in the management of patients with asthma. This procedure uses radiofrequency ener- gy to reduce the mass of smooth muscle in the walls of conducting airways, thereby reducing the potential for smooth muscle-mediated bronchoconstriction. Is bronchial thermoplasty safe, and does it work? Yes, according to a study conducted in Canada by Cox and associates.

ROCHESTER, Minn. -- An elevated inflammatory response in patients with atopic allergic diseases, especially allergic rhinitis, may predispose them to Parkinson's disease, suggested researchers here.

TORONTO -- Perhaps patients in their 70s should be advised to play it cool on their birthdays. The excitement surrounding the event increases the risk of stroke and heart attacks, according to researchers here.

NEW YORK -- Firefighters and EMS personnel exposed to the dust and smoke at ground zero during the World Trade Center disaster had declines in lung function a year later that were equivalent to 12 years of pulmonary aging.

Abstract: Tracheobronchomalacia is a form of expiratory central airway collapse characterized by softening of the airway wall cartilaginous structures. Symptoms often mimic asthma and chronic obstructive pulmonary disease. Pulmonary function test results may suggest a diagnosis, but findings are neither sensitive nor specific. Bronchoscopy and novel dynamic radiographic studies contribute to the diagnosis and help differentiate true malacia from other forms of expiratory central airway collapse. Treatment options include medication; noninvasive ventilatory support; interventional bronchoscopy with airway stent insertion; and open surgical procedures, such as tracheostomy, tracheal resection, and tracheoplasty. (J Respir Dis. 2006;27(8):327-335)

An 8-year-old boy presented with a 6-week history of shortness of breath, cough, and myalgias, but no fever. His pediatrician had made the diagnosis of bronchiolitis, and the patient was treated with azithromycin and albuterol via a metered-dose inhaler. Because the patient did not improve, he was given a 10-day course of amoxicillin, followed by a course of clarithromycin after a chest radiograph revealed bilateral infiltrates, suggesting atypical pneumonia.

Effective asthma control involves the assessment of symptoms, changes in pulmonary function, and effects on quality of life and functional ability. A 5-item, patient-administered survey, the Asthma Control Test (ACT), has been developed as an assessment tool (Table). Investigators evaluated the reliability and validity of the ACT in a longitudinal study of patients with asthma who were new to the care of an asthma specialist.

SACRAMENTO, Calif. -- Rescue inhalers for asthmatics don't keep track of bronchodilator doses used or remaining, leaving some patients in the lurch when they need the drugs most.