Effects of high dose inhaled beclomethasone dipropionate, 750 micrograms and 1500 micrograms twice daily, and 40 mg per day oral prednisolone on lung function, symptoms, and bronchial hyperresponsiveness in patients with non-asthmatic chronic airflow obstruction.

Preschool wheeze is a common and often difficult to treat symptom. It may rarely be the first presentation of a severe underlying condition. Preschool wheeze is clearly a syndrome, not a single entity, and thus ripe for phenotyping. A number of approaches to phenotyping have been adopted. Epidemiology, based on the temporal patterns of symptoms, has taught us a lot about the medium and long-term implications of early life events, but is not useful for treatment planning. Atopic status is also not useful. Instead, symptom pattern (episodic (viral) and multiple trigger) should be used to decide on treatment. Reduced lung function at birth is associated with a number of maternal factors, including smoking (both by direct and epigenetic mechanisms), atopic status, and pregnancy complications; these children tend to have transient wheeze. Children whose symptoms persist into mid-childhood are born with normal lung function, but have evidence of airflow obstruction at 4–6 years of age. Early atopic sensitization is important in this group. Treatment of pre-school wheeze should be based on relief of present symptoms; there is no known therapy which prevents progression from episodic to multiple trigger symptoms and asthma. Episodic (viral) wheeze is a neutrophilic disease and should be treated with intermittent therapy. Options include inhaled anticholinergics or short-acting β-2 agonists, oral leukotriene receptor antagonists and short-course, high-dose inhaled corticosteroids. Prophylactic inhaled corticosteroids are not useful. Neither prophylactic nor inhaled corticosteroids are effective in preventing progression from an episodic viral to a multiple-trigger pattern. Multipletrigger wheeze may merit a three-step trial (trial period, stop if apparent response, restart only if symptoms return) of prophylactic inhaled corticosteroids or leukotriene receptor antagonists. Recent data have shown that prednisolone should not be a routine treatment for acute exacerbations of episodic (viral) wheeze, but should only be used for really severe excacerbations, defined as being more severe than a routine admission and likely needing high dependency care. This is especially true in the setting of multiple trigger wheeze. Keywords: asthma, inhaled corticosteroid, leukotriene, neutrophil, prednisolone

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Serum bilirubin and chronic obstructive pulmonary disease (COPD): a systematic review

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01395-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

David M. MacDonald ◽

Ken M. Kunisaki ◽

Timothy J. Wilt ◽

Arianne K. Baldomero

Keyword(s):

Systematic Review ◽

Health Status ◽

Lung Function ◽

Serum Bilirubin ◽

Respiratory Health ◽

Airflow Obstruction ◽

Risk Of Bias ◽

Chronic Obstructive ◽

Strength Of Evidence ◽

Acute Exacerbations

Abstract Background Bilirubin is a potent antioxidant and higher serum bilirubin levels have been associated with improved COPD outcomes. We performed a systematic review to evaluate the association between serum bilirubin levels and lung function (FEV1), prevalence/incidence of COPD, acute exacerbations of COPD, respiratory health status, and mortality. Methods MEDLINE® and Embase were searched using Ovid® (search updated October 1st, 2019). We included studies that measured serum bilirubin levels and outcomes of interest in adults with or without underlying lung disease. We excluded studies of those with liver disease or drug-induced elevations in bilirubin. We used the Newcastle–Ottawa scale to assess individual study risk of bias (ROB) and the US Agency for Healthcare Research and Quality—Evidence Based Practice tool to assess overall strength of evidence (SOE). Two authors independently determined eligibility, performed data abstraction, assessed ROB, and determined SOE. Results Thirteen studies (5 low risk of bias, 3 moderate and 5 high risk) were included. We found low strength of evidence for the association between higher bilirubin levels and lower risk of acute exacerbations of COPD (2 studies), mortality (3 studies), COPD diagnosis (4 studies), and lung function (FEV1) (8 studies). We found insufficient evidence on the relationship between serum bilirubin and respiratory health status/exercise capacity (1 study) and airflow obstruction (FEV1/FVC ratio) (4 studies). Conclusion Higher bilirubin levels may be associated with lower mortality and improved COPD outcomes. Randomized trials are needed to evaluate the effect of medications that raise serum bilirubin on COPD outcomes. PROSPERO registration: CRD42019145747.

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Novel perspectives of super-high dose sulfonylurea and high-dose oral prednisolone in an infant with DEND syndrome due to V64M heterozygote KCNJ11 mutation

Acta Diabetologica ◽

10.1007/s00592-021-01763-1 ◽

2021 ◽

Author(s):

Galia Barash ◽

Haim Bassan ◽

Ayelet Livne ◽

Lilach Benyamini ◽

Eli Heyman ◽

...

Keyword(s):

Oral Prednisolone ◽

High Dose ◽

Dose Oral

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DNA methylation is associated with airflow obstruction in patients living with HIV

Thorax ◽

10.1136/thoraxjnl-2020-215866 ◽

2020 ◽

pp. thoraxjnl-2020-215866

Author(s):

Ana I Hernandez Cordero ◽

Chen Xi Yang ◽

Maen Obeidat ◽

Julia Yang ◽

Julie MacIsaac ◽

...

Keyword(s):

Dna Methylation ◽

Lung Function ◽

Viral Infections ◽

Airflow Obstruction ◽

Normal Lung ◽

People Living With Hiv ◽

Global Methylation ◽

Age Related ◽

Impaired Lung Function ◽

Living With Hiv

IntroductionPeople living with HIV (PLWH) suffer from age-related comorbidities such as COPD. The processes responsible for reduced lung function in PLWH are largely unknown. We performed an epigenome-wide association study to investigate whether blood DNA methylation is associated with impaired lung function in PLWH.MethodsUsing blood DNA methylation profiles from 161 PLWH, we tested the effect of methylation on FEV1, FEV1/FVC ratio and FEV1 decline over a median of 5 years. We evaluated the global methylation of PLWH with airflow obstruction by testing the differential methylation of transposable elements Alu and LINE-1, a well-described marker of epigenetic ageing.ResultsAirflow obstruction as defined by a FEV1/FVC<0.70 was associated with 1393 differentially methylated positions (DMPs), while 4676 were associated with airflow obstruction based on the FEV1/FVC<lower limit of normal. These DMPs were enriched for biological pathways associated with chronic viral infections. The airflow obstruction group was globally hypomethylated compared with those without airflow obstruction. 103 and 7112 DMPs were associated with FEV1 and FEV1/FVC, respectively. No positions were associated with FEV1 decline.ConclusionA large number of DMPs were associated with airflow obstruction and lung function in a unique cohort of PLWH. Airflow obstruction in even relatively young PLWH is associated with global hypomethylation, suggesting advanced epigenetic ageing compared with those with normal lung function. The disturbance of the epigenetic regulation of key genes not previously identified in non-HIV COPD cohorts could explain the unique risk of COPD in PLWH.

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Occupational exposure to water-based paints and self-reported asthma, lower airway symptoms, bronchial hyperresponsiveness, and lung function

International Archives of Occupational and Environmental Health ◽

10.1007/bf00454365 ◽

1994 ◽

Vol 66 (4) ◽

pp. 261-267 ◽

Cited By ~ 26

Author(s):

G. Wieslander ◽

C. Janson ◽

D. Norb�ck ◽

E. Bj�rnsson ◽

G. St�lenheim ◽

...

Keyword(s):

Occupational Exposure ◽

Lung Function ◽

Bronchial Hyperresponsiveness ◽

Lower Airway ◽

Airway Symptoms ◽

Water Based

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Household Food Insecurity, Lung Function, and COPD in US Adults

Nutrients ◽

10.3390/nu13062098 ◽

2021 ◽

Vol 13 (6) ◽

pp. 2098

Author(s):

Francisca de Castro Mendes ◽

Kirstie Ducharme-Smith ◽

Gustavo Mora-Garcia ◽

Saleh A. Alqahtani ◽

Maria Stephany Ruiz-Diaz ◽

...

Keyword(s):

Lung Function ◽

Food Insecurity ◽

Representative Sample ◽

Airflow Obstruction ◽

Forced Expiratory Volume ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

The Us ◽

Nationally Representative ◽

Lung Health

Increasing epidemiological evidence suggests that optimal diet quality helps to improve preservation of lung function and to reduce chronic obstructive pulmonary disease (COPD) risk, but no study has investigated the association of food insecurity (FI) and lung health in the general population. Using data from a representative sample of US adults who participated in the National Health and Nutrition Examination Survey (NHANES) 2007–2012 cycles, we investigated the association between FI with lung function and spirometrically defined COPD in 12,469 individuals aged ≥ 18 years of age. FI (high vs. low) was defined using the US Department of Agriculture’s Food Security Scale). Population-weighted adjusted regression models were used to investigate associations between FI, and forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), their ratio, and spirometrically defined restriction (FVC below the lower limit of normal) and airflow obstruction (COPD). The prevalence of household FI was 13.2%. High household FI was associated with lower FVC (adjusted β-coefficient −70.9 mL, 95% CI −116.6, −25.3), and with higher odds (OR) of spirometric restriction (1.02, 95% CI 1.00, 1.03). Stratified analyses showed similar effect sizes within specific ethnic groups. High FI was associated with worse lung health in a nationally representative sample of adults in the US.

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Prevalence and burden of chronic bronchitis symptoms: results from the BOLD study

European Respiratory Journal ◽

10.1183/13993003.00621-2017 ◽

2017 ◽

Vol 50 (5) ◽

pp. 1700621 ◽

Cited By ~ 19

Author(s):

Filip Mejza ◽

Louisa Gnatiuc ◽

A. Sonia Buist ◽

William M. Vollmer ◽

Bernd Lamprecht ◽

...

Keyword(s):

Lung Function ◽

Lung Disease ◽

Chronic Bronchitis ◽

Airflow Obstruction ◽

Population Based ◽

Normal Lung ◽

Increased Risk ◽

Potential Risk Factors ◽

Definition Of ◽

Disease Study

We studied the prevalence, burden and potential risk factors for chronic bronchitis symptoms in the Burden of Obstructive Lung Disease study.Representative population-based samples of adults aged ≥40 years were selected in participating sites. Participants completed questionnaires and spirometry. Chronic bronchitis symptoms were defined as chronic cough and phlegm on most days for ≥3 months each year for ≥2 years.Data from 24 855 subjects from 33 sites in 29 countries were analysed. There were significant differences in the prevalence of self-reported symptoms meeting our definition of chronic bronchitis across sites, from 10.8% in Lexington (KY, USA), to 0% in Ile-Ife (Nigeria) and Blantyre (Malawi). Older age, less education, current smoking, occupational exposure to fumes, self-reported diagnosis of asthma or lung cancer and family history of chronic lung disease were all associated with increased risk of chronic bronchitis. Chronic bronchitis symptoms were associated with worse lung function, more dyspnoea, increased risk of respiratory exacerbations and reduced quality of life, independent of the presence of other lung diseases.The prevalence of chronic bronchitis symptoms varied widely across the studied sites. Chronic bronchitis symptoms were associated with significant burden both in individuals with chronic airflow obstruction and those with normal lung function.

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Sudden onset blindness treated with pulse steroid therapy in a patient with microscopic polyangiitis

Open Medicine ◽

10.2478/s11536-011-0069-2 ◽

2011 ◽

Vol 6 (5) ◽

pp. 631-633

Author(s):

Yoshiro Horai ◽

Tomoya Miyamura ◽

Karin Shimada ◽

Soichiro Takahama ◽

Rumi Minami ◽

...

Keyword(s):

Steroid Therapy ◽

Microscopic Polyangiitis ◽

Oral Prednisolone ◽

Sudden Onset ◽

High Dose ◽

Pulse Steroid Therapy ◽

Ocular Manifestations ◽

Dose Oral ◽

The Right ◽

Pulse Steroid

AbstractWe report a 71-year-old male with microscopic polyangiitis (MPA) who developed sudden-onset, progressive, bilateral visual loss associated with a relapse of MPA symptoms. The patient was referred to our hospital, and treated with intravenous pulse steroid therapy and high-dose oral prednisolone. Although the right eye remained vision deficient, visual acuity in the left eye recovered. Ocular manifestations of MPA are quite uncommon. This case emphasizes the necessity of early detection and initiation of prompt therapy where ocular manifestations of MPA occur.

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