scholarly journals Patients with Severe Asthma: Analysis of Future Risks

2021 ◽  
Vol 15 (5) ◽  
pp. 893-897
Author(s):  
Sajida Parveen ◽  
Ghufran Zafar ◽  
Rukhshanda Nosheen
Keyword(s):  
Adverse Effect ◽  
Severe Asthma ◽  
Acute Asthma ◽  
The Other ◽  
Lung Damage ◽  
Routine Practice ◽  
Asthma Risk ◽  
Oral Corticosteroids ◽  
Keywords Asthma

The upcoming severe health problems can be due to the asthmatic burdens. Severe asthma can lead to dangerous exacerbation and damage of pulmonary function. It can also affect medication-related problems for example steroids. In routine practice, the risk of asthma is not easily detectable. The present tools for the measurement and diagnosis of asthma and asthma-related morbidity cannot surely predict the upcoming risks of morbidity due to medication. The article reviews the existing evidence of upcoming danger in people with asthma. This review is pivoted on the danger in people with “controlled” acute asthma. It is obvious from some studies that long-term use of corticosteroids cannot stop the progression of asthma and lung damage. The other results show that the adverse effect of the drugs increases even with the lesser dose of oral corticosteroids. So, there is a need for new therapies for the reduction of upcoming risks due to asthma. Keywords: Asthma, Risk, Severity.

Severe Acute Asthma in a Pediatric Intensive Care Unit: Six Years' Experience

PEDIATRICS ◽  
1989 ◽  
Vol 83 (6) ◽  
pp. 1023-1028
Author(s):  
Renato Stein ◽  
Gerard J. Canny ◽  
Desmond J. Bohn ◽  
Joseph J. Reisman ◽  
Henry Levison
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Severe Asthma ◽  
Acute Asthma ◽  
Mortality And Morbidity ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Oral Corticosteroids ◽  
Severe Acute Asthma ◽  
At Home

The management of children with severe acute asthma who required admission to the intensive care (ICU) of this hospital during 1982 to 1988 was reviewed retrospectively. A total of 89 children were admitted to the ICU on 125 occasions. During the study period, 24% of the patients were admitted to the ICU on more than one occasion. Prior to admission to this hospital, patients had been symptomatic for a mean of 48 hours. Although all patients had received bronchodilators before admission to hospital, only 23% of patients had received oral corticosteroids. According to initial arterial blood gas values determined in the ICU, 77% of the patients had hypercapnia (PaCO2 >45 mm Hg). The pharmacologic agents used in the ICU included nebulized β2agonists (100% of admissions), theophylline (99%), steroids (94%), nebulized ipratropium bromide (10%), IV albuterol (38%), and IV isoproterenol (10%). Mechanical ventilation was necessary in 33% of admissions; the mean duration of ventilation was 32 hours. Ten patients had pneumothorax; in six cases, these were related to mechanical ventilation. Three of the patients who received mechanical ventilation died, representing a mortality of 7.5%. In each of these patients, sudden, severe asthma episodes had developed at home, resulting in respiratory arrest. They had evidence of hypoxic encephalopathy at the time of admission to the ICU and eventually were declared brain dead. It was concluded that delay in seeking medical care and underuse of oral corticosteroids at home may have contributed to the need for ICU admission. The mortality and morbidity for children with severe asthma who require ICU admissions are small, provided that bronchodilators and IV steroids are used optimally and that patients who require mechanical ventilation are carefully selected.

scholarly journals Patient's experience of asthma exacerbation and management: a qualitative study of severe asthma

2020 ◽  
pp. 00528-2020
Author(s):  
Woo-Jung Song ◽  
Ha-Kyeong Won ◽  
Suh Young Lee ◽  
Han-Ki Park ◽  
You Sook Cho ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Severe Asthma ◽  
Asthma Exacerbation ◽  
Qualitative Interviews ◽  
Health Consequences ◽  
Patient’S Experience ◽  
Oral Corticosteroids ◽  
Tertiary Hospitals ◽  
Systematic Education

BackgroundExacerbation is a defining feature of severe asthma, and oral corticosteroids (OCSs) are frequently prescribed to manage exacerbations. This qualitative study was conducted to examine the experience of patients with severe asthma, with a focus on asthma exacerbation and OCS treatment.MethodsAdults with severe asthma were recruited from three tertiary hospitals in South Korea. Data were collected through in-depth qualitative interviews. Verbatim transcripts were analysed using Colaizzi's phenomenological method to uncover the meaning of the participants’ experience. Recruitment of participants continued until thematic saturation.ResultsFourteen patients with severe asthma were recruited. Four theme clusters emerged: 1) experience of asthma exacerbation, 2) impact on life, 3) OCS treatments, and 4) disease perception. The patients experienced severe physical and psychosocial distress from asthma exacerbations, felt helpless due to failed efforts to prevent exacerbation, and were living a restricted life due to fear of exacerbation. They feared OCS side effects but had no other choice but to rely on OCS because other interventions were ineffective. Most had poor knowledge and understanding of severe asthma and the longterm health consequences.ConclusionAsthma exacerbation affects wide aspects of life in patients with severe asthma. Several components may underlie OCS reliance, including experience of distress during exacerbation, fear of future exacerbation, and lack of proper knowledge about long-term health consequences of severe asthma and OCS treatments. Multi-disciplinary approach is warranted to support the patients and to provide systematic education about long-term health implications of severe asthma.

Estimated doses of melatonin for treating deadly virus infections: focus on COVID-19

2020 ◽  
Vol 3 (3) ◽  
pp. 276-296 ◽  
Author(s):  
Dun-Xian Tan ◽  
Rüdiger Hardeland
Keyword(s):  
Adverse Effect ◽  
Animal Studies ◽  
Viral Infections ◽  
Biological Significance ◽  
The Other ◽  
Virus Infections ◽  
Limited Disease ◽  
Daily Dose ◽  
Long Term Experience

Increased evidence implies that melatonin may be a promising molecule for combating COVID-19 due to its potent antioxidative, anti-inflammatory and immunoregulatory capacities. A frequently asked question concerns the suitable dosage of melatonin for deadly virus infections including COVID-19 patients. The golden standards for a suitable dosage of medicine are safety and effectiveness. By reviewing the pharmacokinetics as well as animal studies and clinical trials of melatonin in the deadly viral infections and sepsis, we estimate that a dose of 8 mg/kg/day of melatonin is suitable for COVID-19 patients, especially for the severe cases. To maintain an elevated melatonin serum level lasting longer and smoother, this daily dose can be divided into 5 sub-doses with the initial dose of doubling over the other sub-doses. The recommended dose is in the ranges used to treat septic patients clinically and is devoid of any adverse effect; thus, it is safe. This dose is calculated from an effective dose which significantly reduces the mortality of virus-infected mice and is, therefore, assumed to be effective for COVID-19 severe patients. In our opinion, a dose or a medicine which can only improve the symptoms of mild or moderately severe patients of COVID-19 lack biological significance since virus infection is a self-limited disease and most of the patients with mild or moderate symptoms will recover by themselves whether treated or not. A meaningful treatment is to target the severe patients and significantly reduce the resulting mortality. The suggested melatonin dose is, thus, mainly recommended for the severe COVID-19 patients. The possibility of using suppositories for the delivery of highly dosed melatonin is also addressed, since long-term experience with this treatment is available for another disease. 

Will Your Breast Cancer Patient’s Mortality Go Up in Smoke?

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
David W. Mantik
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Recurrence Risk ◽  
The Other ◽  
Lung Damage ◽  
Major Contributor ◽  
Capillary Perfusion ◽  
Cell Hypoxia ◽  
Excited Luminescence

Dedicated smokers who receive breast radiation may pay an unexpected price[1]in both recurrence risk and in mortality. Smoking during radiation therapy (RT) noticeably increases (and accelerates) the recurrence risk, but it also increases long-term risks of lung and heart mortality. The recurrence risk probably derives from (temporary) smoking - caused hypoxia. On the other hand, concurrent RT and smoking produces synergistic and permanent heart and lung damage. Tumor cell hypoxia can be exogenous (via smoking) or endogenous (inadequate capillary perfusion) or possibly even environmental (at high altitudes). However it occurs, though, it is a major contributor to treatment failure. Techniques for addressing hypoxia - both currently in the clinic, and on the technological horizon - are briefly reviewed here. These include photoacoustics, FLASH radiotherapy, and Cherenkov - Excited Luminescence Imaging (CELI).

scholarly journals Can Aaripiprazole Normalize Yatrogenic Hyperprolactinemia?

2020 ◽  
Author(s):  
Roberto Lozano ◽  
Reyes Marin ◽  
Asuncion Pascual ◽  
María-Jesús Santacruz
Keyword(s):  
Adverse Effect ◽  
Metabolic Syndrome ◽  
Combined Treatment ◽  
The Other ◽  
Gonadal Function ◽  
Short Term ◽  
Thromboembolic Risk ◽  
Partial Dopamine Agonist ◽  
The Ideal

Aripiprazole is a second generation atypical antipsychotic (AAP), with properties of partial dopamine agonist, used in schizophrenia, bipolar disorder and depression, among others. On the other hand, the side effects associated with AAP treatment are drug-specific, with hyperprolactinemia and metabolic syndrome being some of the most important. Hyperprolactinemia is an adverse effect with consequences both in the short term, alterations in gonadal function and parkinsonism, and in the long term, osteopenia-osteoporosis, metabolic syndrome and / or increased thromboembolic risk. Therefore, normalization or reduction of prolactinemia is sufficient to avoid them. According to our results, aripiprazole would be the ideal component for the combined treatment with those other antipsychotics that cause hyperprolactinemia, such as risperidone, reducing it and alleviating or eliminating the adverse effects derived from chronic hyperprolactinemia.

Management of difficult to treat severe asthma—what's the evidence?

2016 ◽  
Vol 54 (11) ◽  
pp. 126-129
Keyword(s):  
Severe Asthma ◽  
Systemic Corticosteroid ◽  
Treatment Options ◽  
Corticosteroid Treatment ◽  
High Dose ◽  
Safety And Efficacy ◽  
International Guidelines ◽  
Frequent Use ◽  
Oral Corticosteroids

The management of adults with asthma that remains uncontrolled despite treatment with high-dose therapies poses a challenge to clinicians and patients. National and international guidelines recommend intensification of treatment that typically involves the use of oral corticosteroids.1,2 The risks associated with long-term systemic corticosteroid treatment are well documented, and have led to the search for alternatives. Recent advances in the understanding of the pathology of asthma have prompted the development of other treatment options. Here, we consider the options available for people who require continuous or frequent use of oral corticosteroids and review the safety and efficacy of such treatments.

Radioimmunotherapy for treatment of acute myeloid leukaemia and myelodysplastic syndrome

2005 ◽  
Vol 44 (03) ◽  
pp. 107-117
Author(s):  
R. G. Meyer ◽  
W. Herr ◽  
A. Helisch ◽  
P. Bartenstein ◽  
I. Buchmann
Keyword(s):  
Acute Myeloid Leukaemia ◽  
Myeloid Leukaemia ◽  
Primary Tumour ◽  
The Other ◽  
Haematopoietic Stem Cell ◽  
Other Hand ◽  
Primary Reduction ◽  
The One ◽  
Acute Myeloid

SummaryThe prognosis of patients with acute myeloid leukaemia (AML) has improved considerably by introduction of aggressive consolidation chemotherapy and haematopoietic stem cell transplantation (SCT). Nevertheless, only 20-30% of patients with AML achieve long-term diseasefree survival after SCT. The most common cause of treatment failure is relapse. Additionally, mortality rates are significantly increased by therapy-related causes such as toxicity of chemotherapy and complications of SCT. Including radioimmunotherapies in the treatment of AML and myelodyplastic syndrome (MDS) allows for the achievement of a pronounced antileukaemic effect for the reduction of relapse rates on the one hand. On the other hand, no increase of acute toxicity and later complications should be induced. These effects are important for the primary reduction of tumour cells as well as for the myeloablative conditioning before SCT.This paper provides a systematic and critical review of the currently used radionuclides and immunoconjugates for the treatment of AML and MDS and summarizes the literature on primary tumour cell reductive radioimmunotherapies on the one hand and conditioning radioimmunotherapies before SCT on the other hand.

Hidden “holes” in the capital of banks and the supply of credit to the real sector of economy

2018 ◽  
pp. 49-68 ◽  
Author(s):  
M. E. Mamonov
Keyword(s):  
Credit Risk ◽  
The Other ◽  
Real Sector ◽  
Capital Management ◽  
Loan Loss ◽  
Short Term ◽  
The Real ◽  
Ex Post ◽  
The One

Our analysis documents that the existence of hidden “holes” in the capital of not yet failed banks - while creating intertemporal pressure on the actual level of capital - leads to changing of maturity of loans supplied rather than to contracting of their volume. Long-term loans decrease, whereas short-term loans rise - and, what is most remarkably, by approximately the same amounts. Standardly, the higher the maturity of loans the higher the credit risk and, thus, the more loan loss reserves (LLP) banks are forced to create, increasing the pressure on capital. Banks that already hide “holes” in the capital, but have not yet faced with license withdrawal, must possess strong incentives to shorten the maturity of supplied loans. On the one hand, it raises the turnovers of LLP and facilitates the flexibility of capital management; on the other hand, it allows increasing the speed of shifting of attracted deposits to loans to related parties in domestic or foreign jurisdictions. This enlarges the potential size of ex post revealed “hole” in the capital and, therefore, allows us to assume that not every loan might be viewed as a good for the economy: excessive short-term and insufficient long-term loans can produce the source for future losses.

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