Asthma

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.

FRIEDRICHSDORF, Germany -- Infant formula laced with prebiotic oligosaccharides modified bowel bacteria and more than halved the risk of atopic dermatitis among high-risk babies, researchers reported.

GLASGOW, Scotland -- Within six weeks of their last cigarette, patients with asthma showed a "clinically significant" 15.2% improvement in lung function, a stark demonstration of the reversible component of the effects of smoking on the airways.

ATLANTA - In the wake of the mass Gulf Coast evacuation from Hurricane Katrina, the most common health condition treated in evacuation centers was chronic disease while injury was the most common problem reported in health-care facilities.

LEICESTER, England - Carbon spewed by cars and trucks is responsible for lowered lung function in otherwise healthy children, according to researchers here.

Abstract: Although excessive daytime sleepiness is most often simply the result of inadequate sleep, other causes must be considered as well. Common causes of daytime sleepiness include obstructive sleep apnea/hypopnea syndrome (OSAHS) and medication side effects. The differential diagnosis also includes narcolepsy and restless legs syndrome (RLS). In many cases, the answers to a few simple questions can provide the necessary clues to the diagnosis. Loud snoring is associated with OSAHS, while sudden muscle weakness triggered by intense emotion is consistent with narcolepsy. Referral for sleep evaluation is indicated to evaluate for OSAHS, narcolepsy, RLS, and idiopathic hypersomnia. Methods of measuring daytime sleepiness include the Multiple Sleep Latency Test and the Epworth Sleepiness Scale. (J Respir Dis. 2005;26(6):253-259)

Abstract: Patients who have aspirin-exacerbated respiratory disease (AERD) usually experience upper and lower respiratory tract symptoms about 1Z|x to 2 hours after taking aspirin or another NSAID that inhibits the enzyme cyclooxygenase-1. In addition to symptoms such as nasal congestion, rhinorrhea, paroxysmal sneezing, periorbital edema, laryngospasm, and intense flushing, patients may have severe--often life-threatening--exacerbations of asthma. AERD occurs in about 10% to 20% of patients with asthma and in about 30% of asthmatic patients with nasal polyposis. However, AERD also occurs in patients who do not have any of these predispos- ing conditions. In patients with AERD, aspirin desensitization can improve asthma control, reduce the need for corticosteroids, and reduce the need for sinus surgery. (J Respir Dis. 2006;27(7):282-290)

The American Academy of Allergy, Asthma, and Immunology (AAAAI) recently published guidelines for referring patients to an allergist/immunologist.1 The recommendations address topics such as rhinitis, asthma, cough, anaphylaxis, dermatitis, urticaria, and food allergy.

A review of the environmental determinants of allergic rhinitis and asthma, including house dust mites, cats, dogs, and cockroaches.

Although the relationship is not completely understood, it is clear that anxiety and depression can adversely affect the course of asthma and chronic obstructive pulmonary disease.

Avoidance of allergens and irritants known to cause or aggravate allergic rhinitis and asthma is a key component in the management of these disorders.

WASHINGTON - Calling secondhand tobacco smoke a significant risk to cardiovascular health, the U.S. Surgeon General today praised states and municipalities that have a banned smoking in the workplace, in bars, and in other public places.

SALT LAKE CITY - Adherence to treatment with continuous positive airway pressure (CPAP) by patients with obstructive sleep apnea may be considerably less than believed.

ODENSE, Denmark ? When individual physicians take part in a drug trial, their developing familiarity with a drug they are testing makes them more likely to use it in everyday practice, suggesting that post-marketing clinical trials are an effective sales tool.

CINCINNATI - When it comes to inducing allergies in young children, not all types of airborne fungal spores are created equal, researchers here said.

LONDON, June 15 - Patients with cystic fibrosis can safely stop using inhaled corticosteroids, according to researchers here.

abstract: Pulmonary arterial hypertension (PAH) is 1 of 5 types of pulmonary hypertension (PH). Symptoms may include dyspnea on exertion, fatigue, near-syncope, and palpitations. Physical findings include lower extremity edema, jugular venous distention, and a loud P2. Findings on chest radiography, transthoracic echocardiography, and electrocardiography can suggest the presence of PAH; however, right heart catheterization is the gold standard for confirming the diagnosis and for differentiating PAH from other forms of PH. It is essential to exclude chronic thromboembolic PH, since this can be surgically corrected. The treatment of PAH depends on the severity. In addition to the standard treatments, such as diuretics and anticoagulation, more advanced treatment options include prostaglandin therapy (epoprostenol, treprostinil, and iloprost), endothelin receptor antagonists (bosentan), and phosphodiesterase inhibitors (sildenafil).

What strategies can reduce the risk of osteoporosis in patients receiving long-term glucocorticoid therapy?

Abstract: A number of factors can complicate the diagnosis of asthma in elderly patients. For example, the elderly are more likely to have diseases such as chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) that--like asthma--can cause cough, dyspnea, and wheezing. Spirometry can help distinguish asthma from COPD, and chest radiography and measurement of brain natriuretic peptide levels can help identify CHF. Important considerations in the management of asthma include drug side effects, drug interactions, and difficulty in using metered-dose inhalers. When discussing the goals of therapy with the patient, remember that quality-of-life issues, such as the ability to live independently and to participate in leisure activities, can be stronger motivators than objective measures of pulmonary function. (J Respir Dis. 2006;27(6):238-247)

CHAPEL HILL, N.C. - Inhaled corticosteroids reduce exacerbations with acceptable side effects in patients with moderate or severe COPD, but not mild disease, shows a meta-analysis.

ROCKVILLE, Md. - The FDA approved a shingles vaccine, and Merck said it is ready to accept physician orders, with rapid shipment promised.

Recent reports have identified potentialrisks of nebulizer use in patientswith environmental allergies.1,2 One report described 2 childrenwith asthma and cockroachallergy who had life-threateningworsening of asthma after using anebulizer to treat an exacerbation.1

Test your knowledge of dermatology with 4 cases, 4 photos, 4 different rashes . . . which are the result of a drug reaction?

Initiation of early aggressive therapy is critical to averting fatal outcomes in exacerbations of acute life-threatening asthma.

The morbidity and mortality of asthma can be reduced by identifying high-risk patients, using objective and subjective measures to detect severe exacerbations, and initiating early medical intervention.

Q:What constitutes the optimal management of asthma ina pregnant patient?