scholarly journals Allergic bronchopulmonary aspergillosis in resistant asthmatics

2021 ◽  
Author(s):  
Gokulakrishnan Harikrishnan ◽  
Govardhini Vaiyakkani ◽  
Sridhar Sundaravadanam
Keyword(s):  
Bronchial Asthma ◽  
Positive Family History ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
Treatment Strategies ◽  
Significant Risk ◽  
Current Investigation ◽  
Prick Test ◽  
Respiratory Events ◽  
Aspergillus Fumigates ◽  
Asthma Patients

Background: Allergic bronchopulmonary aspergillosis (ABPA) is an immune mediated lung disease caused due to hypersensitivity reaction of antigen Aspergillus fumigates. ABPA is more prevalent in patients with asthma and cystic fibrosis. Thus, the current investigation was done to estimate the prevalence and association of ABPA with resistant asthma, to identify the clinical and laboratory pointers of ABPA and to identify the effect of ABPA and its treatment on the course of resistant asthma.Methods: Current investigation was a prospective and non-blinded study conducted on patients of Rajiv Gandhi government general hospital, Chennai with bronchial asthma, having frequent exacerbation related problems. Demographic, clinical (hematological) and radiological investigations were performed for staging and treatment of all the enrolled patients. Follow up of patients was done periodically to investigate re-admission of respiratory events or other illnesses. All the collected data was statistically analyzed.Results: Prevalence of ABPA in treatment resistant bronchial asthma patients was 19%. Positive family history, history of atopy and recurrent exacerbations were identified as significant risk factors among ABPA patients. Whereas duration and severity of asthma had no significant association with ABPA patients, bronchiectasis and parenchymal damage were significantly observed in patients of ABPA. Skin prick test serum eosinophils and IgE antibody levels were observed as good screening test parameters to identify ABPA. Prednisolone and itraconazole are considered as highly reliable and effective treatment strategies in ABPA.Conclusions: Current investigation revealed that ABPA must be considered as a possible prevailing disease in treatment refractory cases of asthma on conventional steroids.

scholarly journals Association between tuberculosis and bronchial asthma

2017 ◽  
Vol 5 (8) ◽  
pp. 3566
Author(s):  
Kranti Garg ◽  
Jai Kishan Karahyla
Keyword(s):  
Family History ◽  
Lung Function ◽  
Bronchial Asthma ◽  
Positive Family History ◽  
Government Medical College ◽  
Medical College ◽  
Asthma Patients ◽  
History Of

Background: Everything that wheezes is not asthma. In patients of tuberculosis (TB), wheezing can be because of bronchial asthma, or many other causes. Asthma and other causes of wheezing need to be differentiated, as the treatment should be planned accordingly.Methods: Patients of active/quiescent tuberculosis who presented to Department of Tuberculosis and Chest Diseases, Government Medical College, Patiala, Punjab, India, with complaints of breathlessness and had rhonchi on examination were subjected to bronchodilator reversibility testing to prove if they were suffering from concomitant asthma. Patients thus found to have tuberculosis along with asthma were analyzed with respect to age, sex, rural urban differences and timing of diagnosis of either disease. Patients who developed asthma after tuberculosis were further analyzed for duration between completion of anti-tubercular treatment (ATT) and onset of asthma, family history of asthma and correlation of radiological manifestations and lung function measurements. Aim was to find association, if any, between tuberculosis and asthma.Results: Over 6 months, 69 patients of tuberculosis along with asthma were found. Only 21/69 (30.4%) patients developed tuberculosis after asthma. 48/69 (69.6%) patients developed asthma after tuberculosis. Majority (25/48=52.1%) of them developed asthma within 5 years of completion of ATT (p=0.020). Only 2/48 (2.9%) patients had a positive family history for asthma. Lung function abnormalities correlated with the extent of radiological involvement in these patients who developed asthma after tuberculosis (p ≤0.0001).Conclusions: Patients of active/quiescent tuberculosis who present with breathlessness and have rhonchi on examination should be treated for asthma only after confirmation of the diagnosis, as there can be other reasons for the same.

MYCOPLASMA AND CHLAMYDIA AS ETHIOLOGICAL FACTORS OF BRONCHIAL ASTHMA IN TERMS OF ETHNOGENESIS

2013 ◽  
Vol 68 (7) ◽  
pp. 57-60
Author(s):  
O. A. Sharavii ◽  
S. V. Smirnova
Keyword(s):  
Immune Response ◽  
Chlamydia Trachomatis ◽  
Blood Serum ◽  
Bronchial Asthma ◽  
Mycoplasma Hominis ◽  
Acute Stage ◽  
Control Group ◽  
Clinical Markers ◽  
Chlamydophila Psittaci ◽  
Asthma Patients

 Aim. The study of the prevalence and clinical peculiarities of Mycoplasmosis and Chlamydiosis in patients with different pathogenic forms of bronchial asthma (BA) taking into account ethnicity of a patient. Subjects and Methods. The research covered 239 subjects – both the Europeoids and the Mongoloids in the city of Krasnoyarsk and the town of Kyzyl, all of them being BA patients of different stages, including acute stage and practically healthy. We had determined antigens Mycoplasma pneumoniae, Mycoplasma hominis, Chlamydophila pneumoniae, Chlamydophila psittaci and Chlamydia trachomatis in smears of mucosa of pharynx and antibodies to these antigens in peripheral blood serum. Results.  We found high frequency of Mycoplasmosis and Chlamydiosis in the inhabitants of Eastern Siberia, BA patients with different pathogenic forms as compared to control group. We had determined ethnic peculiarities of specific immune response: IgM to М. pneumoniae was revealed in the Europoids more frequently than in the Mongoloids, but IgM to С. pneumoniae and to C. trachomatis, C. trachomatis antigens had been revealed more often in the Mongoloids than in the Europoids. We accepted as clinical equivalents of Mycoplasmosis and Chlamydiosis diagnostics the following signs: temperature around 37C (subfebrile temperature), non-intensive but stable coughing with scanty mucous and muco-purulent sputum, dyspnea of mixed character. Conclusions. Mycoplasma and Chlamydia are meaningful etiologic factors of bronchial asthma. We have found the peculiarities of immune response depending on ethnicity of a patient (ethnic belonging). Clinical markers of Mycoplasmosis and Chlamydiosis should be taken into account in bronchial asthma in order to provide diagnostics timely as well as eradication of infection agents. Because of insufficient knowledge of problem of bronchial asthma related to contamination with Мycoplasma and Chlamydia we put the goal to study the frequency of Mycoplasmosis and Chlamydiosis occurrence in bronchial asthma patients and determine the characteristics clinical course of diseases. We defined antigens Мycoplasma pneumoniae, Мycoplasma hominis, Chlamydophila pneumoniaе, Chlamydophila psittaci, Chlamydia trachomatis in smears of oropharynx mucosa and antibodies to them in blood serum. 

Real-World Data Evaluation Of Total IgE, Specific IgE And Omalizumab Therapy In A Cohort Of Allergic Asthma Patients Treated In A Community-Based Practice

2020 ◽  
Author(s):  
Fortune O Alabi
Keyword(s):  
Allergic Asthma ◽  
Specific Ige ◽  
Forced Expiratory Volume ◽  
Act Scores ◽  
Asthma Control Test ◽  
Real World Data ◽  
Total Ige ◽  
Prick Test ◽  
Negative Results ◽  
Asthma Patients

Objective: In this study, we: (1) evaluated the correlation between total IgE and the presence of specific IgE; (2) compared the characteristics of patients with positive specific IgE to those with negative specific IgE; and, (3) analyzed the allergic testing results of patients on omalizumab and reported the effect of omalizumab on forced expiratory volume (FEV1) and asthma control test (ACT) results. Methods: Data from patients diagnosed with allergic asthma and seen at Florida Lung, Asthma & Sleep Specialists (FLASS) between January 2016 and June 2019 were analyzed. Parameters evaluated were total IgE, and levels of specific IgE to antigens in the ImmunoCAP test and skin prick test (SPT). Additional parameters for patients on omalizumab therapy for at least 6 months were FEV1, % predicted FEV1 and ACT results. Results: A total of 475 patients (114 males, 361 females) met the inclusion criteria. The mean age was 53 years (range: 17 to 89 years). Of these, 36 patients were not included in the analysis due to incomplete data. Mean total IgE was higher in patients with positive ImmunoCAP results compared to those with negative results (396 KU/L vs. 81.3 KU/L). There was a significant positive correlation between total IgE and levels of positive specific IgE in the ImmunoCAP test (p<0.0001, r=0.36, n=213 patients). The correlation between total IgE and levels of positive allergens in SPT was not significant (p=0.15, n=44 patients) Two positive reactions to allergens were seen in 22% of ImmunoCAP tests and 13% of SPT tests. There was no statistically significant improvement in FEV1 (p=0.097, CI -0.17 to 0.02) and % predicted FEV1 (p=0.109, CI -6.63 to 0.70) in patients who used omalizumab for at least 6 months. There was a statistically significant improvement in ACT scores (p=0.031, CI -4.21 to -0.21) in patients who used omalizumab for at least 6 months. Conclusion: Allergic asthma could be seen in patients who had an absence of specific IgE in ImmunoCAP and a negative reaction to SPT. The benefit of omalizumab therapy is not limited to allergic asthma patients with positive specific IgE.

scholarly journals Markers of disease severity and positive family history are associated to significant risk perception in rheumatoid arthritis, while compliance with therapy is not: a cross-sectional study in 415 Mexican outpatients

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Irazú Contreras-Yáñez ◽  
Pilar Lavielle ◽  
Patricia Clark ◽  
Virginia Pascual-Ramos
Keyword(s):  
Rheumatoid Arthritis ◽  
Regression Analysis ◽  
Risk Perception ◽  
Family History ◽  
Disease Activity ◽  
Short Form ◽  
Demographic Data ◽  
Multiple Logistic Regression Analysis ◽  
Positive Family History ◽  
Significant Risk

Abstract Background Assessing risk perception (RP) helps explain how rheumatoid arthritis (RA) patients integrate their ideas concerning the disease and how this understanding affects their self-care management. Compliance with treatment impacts disease-related outcomes and could be associated with RP to variable degrees and at different levels. The primary objective was to determine a potential association between RP and compliance with therapy in RA outpatients and to identify additional factors. The secondary objective was to identify factors associated with judgment bias such as unrealistic RP. Patients and methods Between January 2018 and June 2019, 450 consecutive outpatients who received RA-related treatment were invited to a face-to-face interview to obtain socio-demographic data, RA-related information, comorbidities, and the following outcomes: adherence, persistence, and concordance with medications assessed with a questionnaire locally designed; RP with the RP questionnaire (RPQ); disease activity with the Routine Assessment of Patient Index Data-3 (RAPID-3); disability with the Health Assessment Questionnaire Disability Index (HAQ-DI); quality of life with Medical Outcomes Study Short Form-36 (SF-36) instrument; pain and overall disease with the respective visual analogue scale (VAS); and health literacy assessed with 3 questions. Significant RP was defined according to a cut-off based on the 75th percentile value of the sample in which the RPQ was validated. Unrealistic RP was defined based on the coincidence of the presence/absence of significant RP and less/more than 7 unfavorable medical criteria. Multiple logistic regression analysis was used. Patients provided written informed consent and the study received Internal Review Board approval. Results There were 415 patients included, primarily middle-aged women with long-standing disease and moderate disease activity. Almost half of the patients were receiving corticosteroids and 15.9% intensive RA-related treatment. There were 44.1% of the patients concordant with treatment and 22.6% had significant RP. The patients’ treatment behavior was not retained in the regression analysis; meanwhile, rheumatoid nodes, surgical joint replacement, family history of RA, and higher RAPID-3 score were associated with significant RP. There were 56 patients with unrealistic RP; significant RP and more unfavorable medical criteria were associated with unrealistic RP. Conclusions Compliance with therapy was not associated with significant RP in RA outpatients.

scholarly journals Diagnosis, Prevention, Treatment and Surveillance of Anthracycline-Induced Cardiovascular Toxicity in Pediatric Cancer Survivors

Hearts ◽  
2021 ◽  
Vol 2 (1) ◽  
pp. 45-60
Author(s):  
Valerie Curren ◽  
Niti Dham ◽  
Christopher Spurney
Keyword(s):  
Pediatric Cancer ◽  
Systolic Function ◽  
Treatment Strategies ◽  
Significant Risk ◽  
Imaging Biomarkers ◽  
Cancer Therapies ◽  
Cardiovascular Toxicity ◽  
Treatment Protocols ◽  
Mechanisms Of Toxicity ◽  
Pediatric Cancer Survivors

Advances in pediatric cancer therapies have dramatically improved the likelihood of survival. As survivors are aging, however, we are now understanding that treatment carries a significant risk of cardiovascular toxicity, which can develop immediately, or even many years after completing therapy. Anthracycline derivates are some of the most commonly used agents in pediatric oncology treatment protocols, which have a dose-dependent correlation with the development of cardiac toxicity. As we learn more about the mechanisms of toxicity, we are developing prevention strategies, including improvements in surveillance, to improve early diagnosis of heart disease. Current survivorship surveillance protocols often include screening echocardiograms to evaluate systolic function by measuring the ejection fraction or fractional shortening. However, these measurements alone are not enough to capture early myocardial changes. The use of additional imaging biomarkers, serum biomarkers, electrocardiograms, as well as cholesterol and blood pressure screening, are key to the early detection of cardiomyopathy and cardiovascular disease. Medical treatment strategies are the same as those used for heart failure from other causes, but earlier recognition and implementation can lead to improved long term outcomes.

Comparison between Compliance of Fluticasone Propionate Diskhaler and of Fluticasone Propionate Diskus in Adult Bronchial Asthma Patients

Respiration ◽  
2006 ◽  
Vol 73 (5) ◽  
pp. 680-684 ◽  
Author(s):  
Takashi Hasegawa ◽  
Eiichi Suzuki ◽  
Katsuya Fujimori ◽  
Takuro Sakagami ◽  
Shinichi Toyabe ◽  
...  
Keyword(s):  
Fluticasone Propionate ◽  
Bronchial Asthma ◽  
Asthma Patients

822 Apnea every 5 minutes

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A321-A321
Author(s):  
Anupamjeet Sekhon ◽  
Ambrose Chiang ◽  
Kingman Strohl ◽  
Eric Yeh
Keyword(s):  
Treatment Strategies ◽  
Standard Of Care ◽  
Lithium Carbonate ◽  
Apnea Hypopnea Index ◽  
Refractory Depression ◽  
Maxillomandibular Advancement ◽  
Respiratory Events ◽  
Perceived Benefit ◽  
Caucasian Female ◽  
Do So

Abstract Introduction Vagal Nerve Stimulators (VNS) are used in refractory epilepsy and depression. VNS are known to decrease airflow, oxygen saturation, and respiratory amplitude during sleep. We present a case of VNS induced OSA that was overlooked for 6 years. Report of case(s) A 63-year-old Caucasian female with refractory depression, hypothyroidism, and obesity presented with snoring and excessive daytime sleepiness (EDS). She had VNS implanted in a research trial for depression. She was on bupropion, duloxetine, lithium carbonate, lamotrigine, olanzapine, and levothyroxine. Polysomnography (PSG) showed moderate OSA with apnea-hypopnea index (AHI) of 25.8 and SpO2 nadir of 83%, and was titrated to bi-level positive airway pressure (PAP). She tried different masks and pressures but her leak and PAP intolerance persisted. There was no improvement in her EDS, and Armodafinil was prescribed for wake promotion. She struggled with bi-level PAP therapy for five years before being considered for hypoglossal nerve stimulator. But was turned down because of VNS presence. She was then recommended maxillomandibular advancement (MMA) but decided against it. She continued PAP therapy until a repeat PSG revealed mild to moderate OSA (AHI 10.9, RDI 17.8, and SpO2 nadir 79%), and it was noted that most of her respiratory events appeared in a regular fashion at 300-second intervals corresponding with the firing of VNS. PSG performed with VNS turned off showed no OSA (AHI 0.8 and SpO2 nadir 85%). PAP therapy was discontinued and subsequent nocturnal pulse oximetry showed normal oxygenation (ODI 15, RDI 17.8, SpO2 &lt;88% for only 1.7 minutes). Her EDS resolved and VNS was eventually removed as per patient’s preference. She was started on a new medical therapy for depression. She continues to be asymptomatic. Conclusion Ascertainment bias led to delay in recognition of the cause of OSA as focus was on treatment only. Lowering the VNS frequency, increasing cycle time, turning it off during sleep or removal can improve respiratory events. The decision to do so depends on perceived benefit and harm of continuing VNS therapy. This case highlights the importance of re-evaluation of causes and treatment strategies when the standard of care is ineffective. Support (if any):

Skin prick test results of child patients diagnosed as bronchial asthma

2007 ◽  
Vol 35 (1) ◽  
pp. 21-24 ◽  
Author(s):  
E. Dibek Misirlioğlu ◽  
M. Reha Cengizlier
Keyword(s):  
Skin Prick Test ◽  
Bronchial Asthma ◽  
Test Results ◽  
Prick Test ◽  
Child Patients
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