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Refractory asthma

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https://www.readbyqxmd.com/read/29780119/a-rare-case-of-isolated-chronic-cough-caused-by-pulmonary-lymphangitic-carcinomatosis-as-a-primary-manifestation-of-rectum-carcinoma
#1
Minami Okayama, Yoshihiro Kanemitsu, Tetsuya Oguri, Takamitsu Asano, Satoshi Fukuda, Hirotsugu Ohkubo, Masaya Takemura, Ken Maeno, Yutaka Ito, Akio Niimi
A 36-year old man was referred to our hospital due to isolated chronic cough that was refractory to anti-asthma medications, including inhaled corticosteroids/long-acting β2 agonists. Chest X-ray showed diffuse nodular and enhanced vascular shadows with Kerley lines in both lungs. A blood analysis showed elevated serum CEA and CA19-9 levels. A transbronchial biopsy revealed well to moderately differentiated adenocarcinoma, the origin of which was immunohistochemically suspected to be the gastrointestinal tract...
May 18, 2018: Internal Medicine
https://www.readbyqxmd.com/read/29766394/treatment-of-eosinophilic-granulomatosis-with-polyangiitis-a-review
#2
Loïc Raffray, Loïc Guillevin
Eosinophilic granulomatosis with polyangiitis (formerly Churg-Strauss syndrome) is a rare type of anti-neutrophil cytoplasm antibody-associated vasculitis. Nevertheless, eosinophilic granulomatosis with polyangiitis stands apart because it has features of vasculitis and eosinophilic disorders that require targeted therapies somewhat different from those used for other anti-neutrophil cytoplasm antibody-associated vasculitides. Considerable advances have been made in understanding the underlying pathophysiology of eosinophilic granulomatosis with polyangiitis that have highlighted the key role of eosinophils and opened new therapeutic opportunities...
May 15, 2018: Drugs
https://www.readbyqxmd.com/read/29756701/prevalence-of-mycoplasma-pneumoniae-infection-in-pediatric-patients-with-acute-asthma-exacerbation
#3
Elías Kassisse, Hecmary García, Linair Prada, Ixora Salazar, Jorge Kassisse
INTRODUCTION: Mycoplasma pneumoniae may be involved in refractory asthma exacerbation. OBJECTIVE: To determine the prevalence of Mycoplasma pneumoniae infection in patients with acute asthma exacerbation. Material and method. A prospective, crosssectional, observational, case-control study was carried out in patients older than 2 years old and younger than 12. Immunoglobulin M (IgM) antibodies were serologically determined for M. pneumoniae, using the NovaLisa® NovaTec kit for enzyme-linked immunosorbent assay (ELISA)...
June 1, 2018: Archivos Argentinos de Pediatría
https://www.readbyqxmd.com/read/29729496/progressive-increase-in-allergen-concentration-abrogates-immune-tolerance-in-ovalbumin-induced-murine-model-of-chronic-asthma
#4
Gurupreet S Sethi, Amarjit S Naura
Persistent inflammation and remodeling of airways are the major hallmarks of asthma. Though airway inflammation diminishes in ovalbumin (OVA)-based mouse model of chronic asthma owing to immune-tolerance linked with repeated allergen exposure, which limits the application of the disease model. Accordingly, the present study was designed to develop a murine model of chronic asthma which presents persistent airway inflammation coupled with remodeling traits. Herein, OVA-sensitized BALB/c mice were challenged with increasing (modified protocol) or constant concentration (conventional protocol) of the allergen for 6 weeks; 3 times/week...
May 2, 2018: International Immunopharmacology
https://www.readbyqxmd.com/read/29729200/reduction-in-polyamine-catabolism-leads-to-spermine-mediated-airway-epithelial-injury-and-induces-asthma-features
#5
Vaibhav Jain, Shikha Raina, Atish Prabhakar Gheware, Rita Singh, Rakhshinda Rehman, Vinny Negi, Tracy Murray Stewart, Ulaganathan Mabalirajan, Adarsh Kumar Mishra, Robert A Casero, Anurag Agrawal, Balaram Ghosh
BACKGROUND: Airway epithelial injury is a crucial component of acute and severe asthma pathogenesis and a promising target for treatment of refractory asthma. However, the underlying mechanism of epithelial injury remains poorly explored. Though high levels of polyamines, mainly spermine, have been found in asthma and co-morbidity, their role in airway epithelial injury and the cause of their altered levels in asthma has not been explored. METHODS: We measured key polyamine metabolic enzymes in lung samples from normal and asthmatic subjects and in mice with OVA-induced allergic airway inflammation (AAI)...
May 5, 2018: Allergy
https://www.readbyqxmd.com/read/29683055/high-frequency-percussive-ventilation-rescue-therapy-in-morbidly-obese-patients-failing-conventional-mechanical-ventilation
#6
Anatoliy Korzhuk, Ashwad Afzal, Ivan Wong, Felix Khusid, Berhane Worku, Iosif Gulkarov
BACKGROUND: Morbidly obese patients with respiratory failure who do not improve on conventional mechanical ventilation (CMV) often undergo rescue therapy with extracorporeal membrane oxygenation (ECMO). We describe our experience with high-frequency percussive ventilation (HFPV) as a rescue modality. METHODS: In a retrospective analysis from 2009 to 2016, 12 morbidly obese patients underwent HFPV after failing to wean from CMV. Data were collected regarding demographics, cause of respiratory failure, ventilation settings, and hospital course outcomes...
January 1, 2018: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29668121/lipofection-of-plasmid-dna-into-human-mast-cell-lines-using-lipid-nanoparticles-generated-by-microfluidic-mixing
#7
Brett A Duguay, Kate Wei-Chen Huang, Marianna Kulka
Mast cells are important immune cells that have significant roles in mediating allergy and asthma. Therefore, studying the molecular mechanisms regulating these and other processes in mast cells is important to elucidate. Methods such as lipofection, transduction, and electroporation are often employed to dissect these mechanisms by disrupting gene expression in mast cell lines. However, as with other leukocytes, human mast cells (HMCs) are often refractory to the delivery of plasmids by lipofection. In this study, we investigated the utility of lipid nanoparticles (LNPs) containing the ionizable cationic lipids 1,2-dioleoyloxy-3-dimethylaminopropane, 1,2-dioleyloxy-3-dimethylaminopropane, or 2,2-dilinoleyl-4-(2-dimethylaminoethyl)-[1,3]-dioxolane for the delivery of plasmid DNA into HMC lines...
April 18, 2018: Journal of Leukocyte Biology
https://www.readbyqxmd.com/read/29649887/clinical-effect-of-endoscopic-vidian-neurectomy-on-bronchial-asthma-outcomes-in-patients-with-coexisting-refractory-allergic-rhinitis-and-asthma
#8
Jingang Ai, Zuozhong Xie, Xiang Qing, Wei Li, Honghui Liu, Tiansheng Wang, Guolin Tan
Background The prevalence of both allergic rhinitis and bronchial asthma is high throughout the world; their mutual influence on each other has been documented in many studies. However, studies regarding surgical intervention are limited. Objective To evaluate the clinical significance of endoscopic vidian neurectomy on bronchial asthma outcomes in patients with coexisting refractory allergic rhinitis and asthma. Methods A total of 109 patients with moderate to severe persistent intractable allergic rhinitis and mild/moderate asthma were allocated to the bilateral endoscopic vidian neurectomy group (group 1) or conservative medication group (group 2) according to the patients' self-selection...
January 1, 2018: American Journal of Rhinology & Allergy
https://www.readbyqxmd.com/read/29611440/new-biologics-for-allergic-diseases
#9
Laurie A Manka, Michael E Wechsler
Allergic conditions such as asthma and atopic dermatitis have a high prevalence but represent a heterogeneous group of diseases despite similar clinical presentation and underlying pathophysiology. A better understanding of the phenotypes and endotypes of these diseases has driven rapid development of biologic medications targeting many steps of the inflammatory pathways. Areas covered: There are 2 major inflammatory pathways that drive allergic diseases: Type-2 (Th-2) inflammation and non-type 2 inflammation...
April 2018: Expert Review of Clinical Immunology
https://www.readbyqxmd.com/read/29609049/type-2-biomarkers-and-prediction-of-future-exacerbations-and-lung-function-decline-in-adult-asthma
#10
Ruth Semprini, Mathew Williams, Alex Semprini, Alice McDouall, James Fingleton, Cecile Holweg, Mark Weatherall, Richard Beasley, Irene Braithwaite
BACKGROUND: Type 2 biomarkers that predict both likelihood of future severe exacerbations and response to monoclonal antibody therapy in asthma, would be useful clinically in identifying patients both at greater risk of hospitalization, and most likely to benefit from monoclonal antibody therapy. OBJECTIVE: To describe the association between the Type 2 biomarkers, blood eosinophils, FeNO, serum periostin, serum IgE and time to severe exacerbation in a broad asthma population...
March 30, 2018: Journal of Allergy and Clinical Immunology in Practice
https://www.readbyqxmd.com/read/29559484/extracorporeal-membrane-oxygenation-ecmo-for-near-fatal-asthma-refractory-to-conventional-ventilation
#11
Usman Maqsood, Nehal Patel
We describe a case of near-fatal asthma, treated successfully by initiation of extracorporeal membrane oxygenation (ECMO). A 29-year-old woman, known asthmatic on steroid inhalers, inhaled/nebulised bronchodilators, long-term oral prednisolone, theophylline and montelukast, presented with acute shortness of breath. She deteriorated following initial treatment with nebulised bronchodilators and magnesium sulfate requiring intubation and mechanical ventilation. Severe bronchospasm ensued following mechanical ventilation and peak airway pressures remained at 55 cm H2 O with intrinsic positive end expiratory pressure(PEEP) of 14 cm H2 O...
March 20, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29556790/feasibility-and-safety-of-general-anesthesia-for-bronchial-thermoplasty-a-description-of-early-10-treatments
#12
Mariko Aizawa, Satoshi Ishihara, Takeshi Yokoyama, Katsuyuki Katayama
Bronchial thermoplasty (BT) is a recently introduced bronchoscopic treatment for patients with asthma refractory to pharmacotherapy. Intraprocedural sedation management is important for successful performance of BT. However, the results of general anesthesia in patients undergoing BT have not been well described. The aim of this study was to evaluate the feasibility and safety of general anesthesia in patients undergoing BT. We retrospectively reviewed the records of 10 consecutive BT treatments performed under general anesthesia in 4 patients...
March 20, 2018: Journal of Anesthesia
https://www.readbyqxmd.com/read/29553094/role-of-regulatory-t-cells-in-airway-inflammation-in-asthma
#13
Tomotaka Kawayama, Takashi Kinoshita, Kazuko Matsunaga, Yoshiko Naito, Jun Sasaki, Yoshikazu Tominaga, Tomoaki Hoshino
Asthma is an allergic disease characterized by chronic airway inflammation, airway hyperresponsiveness (AHR), reversibility and remodeling. Inhaled corticosteroids (ICS) are effective in many patients with asthma. However, ICS are a controlling, but not but curative treatment, and there are still many patients with refractory and difficult-to-treat asthma. The evaluation of airway inflammation by induced sputum, non-specific AHR by methacholine, and asthmatic reactions by specific allergen challenge techniques are useful not only to investigate the pathogenesis of asthma but also to help develop new drugs for asthma management...
March 16, 2018: Kurume Medical Journal
https://www.readbyqxmd.com/read/29527382/bronchogenic-cyst-as-an-unusual-cause-of-a-persistent-cough-and-wheeze-in-children-a-case-report-and-literature-review
#14
Ahmed Abushahin, Abdulla Zarroug, Magda Wagdi, Ibrahim Janahi
Wheezing and cough are common case scenarios that pediatricians encountered in their office practices. Although a bronchogenic cyst is an uncommon condition, it is essential to be considered in the differential diagnosis of a chronic cough and wheezing among young children who fail to respond to appropriate medical treatment. A 28-month-old girl was referred to our pediatric pulmonology clinic with persistent symptoms of a cough and wheeze unresponsive to standard asthma therapy. This presentation prompted us to undertake a detailed diagnostic evaluation...
2018: Case Reports in Pediatrics
https://www.readbyqxmd.com/read/29524537/refractory-airway-type-2-inflammation-in-a-large-subgroup-of-asthmatic-patients-treated-with-inhaled-corticosteroids
#15
Michael C Peters, Sheena Kerr, Eleanor M Dunican, Prescott G Woodruff, Merritt L Fajt, Bruce D Levy, Elliot Israel, Brenda R Phillips, David T Mauger, Suzy A Comhair, Serpil C Erzurum, Mats W Johansson, Nizar N Jarjour, Andrea M Coverstone, Mario Castro, Annette T Hastie, Eugene R Bleecker, Sally E Wenzel, John V Fahy
BACKGROUND: Airway type 2 inflammation is usually corticosteroid sensitive, but the role of type 2 inflammation as a mechanism of asthma in patients receiving high-dose inhaled corticosteroids (ICSs) is uncertain. OBJECTIVE: We sought to determine whether airway type 2 inflammation persists in patients treated with ICSs and to evaluate the clinical features of patients with steroid-resistant airway type 2 inflammation. METHODS: We used quantitative PCR to generate a composite metric of type 2 cytokine gene expression (type 2 gene mean [T2GM]) in induced sputum cells from healthy control subjects, patients with severe asthma receiving ICSs (n = 174), and patients with nonsevere asthma receiving ICSs (n = 85)...
March 7, 2018: Journal of Allergy and Clinical Immunology
https://www.readbyqxmd.com/read/29519312/a-62-year-old-woman-with-refractory-wheezing
#16
Abhishek Biswas, Hiren J Mehta, Michael A Jantz
A 62-year-old Hispanic woman, a resident of Puerto Rico, presented with symptoms of chronic cough and shortness of breath for the past 2 years that were slowly and progressively getting worse. She received a diagnosis of asthma on the basis of her history of symptomatic "wheezing" and had been on treatment with inhaled bronchodilators and corticosteroids with minimal symptomatic improvement. The peculiarity of her symptoms was that her dyspnea was worse when she was reclining in bed and she would often hear a "whistling" noise in her throat during those times...
March 2018: Chest
https://www.readbyqxmd.com/read/29501297/tracheal-paraganglioma-presenting-as-stridor-in-a-pediatric-patient-case-report-and-literature-review
#17
REVIEW
Amy L Dimachkieh, Allison Dobbie, Damon R Olson, Mark A Lovell, Jeremy D Prager
OBJECTIVE: To review tracheal paragangliomas and describe the clinical presentation, radiologic findings, operative management, and histologic findings of a pediatric patient who presented with stridor refractory to traditional asthma therapy. METHODS: Chart review of an 8-year-old male who presented to a tertiary care pediatric hospital and literature review of tracheal paragangliomas. RESULTS: We present the case of an 8-year-old male who presented with new-onset of wheezing and dyspnea on exertion...
April 2018: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/29486712/acute-coronary-syndrome-secondary-to-allergic-coronary-vasospasm-kounis-syndrome-a-case-series-follow-up-and-literature-review
#18
Jing Li, Jingang Zheng, Yifeng Zhou, Xiaofei Liu, Wenhua Peng
BACKGROUND: Kounis syndrome (KS) is the concurrence of acute coronary syndrome associated with mast-cell and platelet activation in the setting of hypersensitivity and allergic or anaphylactic insults. Many drugs and environmental exposures had been reported as inducers, but various inducers and the mechanism of KS remained unknown till now. The widely used traditional Chinese medicine (TCM) as a potential sensitizer were scarcely reported to induce allergic vasospasm due to the ignorance of the linkage between traditional medicine allergy and vasospasm...
February 27, 2018: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/29453280/elevated-expression-of-il-33-and-tslp-in-the-airways-of-human-asthmatics-in-vivo-a-potential-biomarker-of-severe-refractory-disease
#19
Yan Li, Wei Wang, Zhe Lv, Yun Li, Yan Chen, Kewu Huang, Chris J Corrigan, Sun Ying
The epithelial cytokines IL-33, thymic stromal lymphopoietin (TSLP), and IL-25 have been implicated in asthma pathogenesis because they promote Th2-type cytokine synthesis, but their expression is relatively poorly documented in "real-life" human asthma. Using bronchoalveolar lavage fluid (BALF), we measured airway concentrations of these mediators and compared them with those of Th1- and Th2-type cytokines, airway infiltration of neutrophils and eosinophils, and lung function in a large group of asthmatic patients with a range of disease severity ( n = 70) and control subjects ( n = 30)...
April 1, 2018: Journal of Immunology: Official Journal of the American Association of Immunologists
https://www.readbyqxmd.com/read/29438772/lumen-area-change-delta-lumen-between-inspiratory-and-expiratory-multidetector-computed-tomography-as-a-measure-of-severe-outcomes-in-asthmatic-patients
#20
Sung Shine Shim, Mark L Schiebler, Michael D Evans, Nizar Jarjour, Ron L Sorkness, Loren C Denlinger, Alfonso Rodriguez, Sally Wenzel, Eric A Hoffman, Ching-Long Lin, David S Gierada, Mario Castro, Sean B Fain
BACKGROUND: Quantitative computed tomographic (QCT) biomarkers of airway morphology hold potential for understanding and monitoring regional airway remodeling in asthmatic patients. OBJECTIVE: We sought to determine whether the change in airway lumen area between total lung capacity (TLC) and functional residual capacity (FRC) lung volumes measured from CT imaging data was correlated with severe outcomes in asthmatic patients. METHODS: We studied 152 asthmatic patients (90 female and 62 male patients) and 33 healthy subjects (12 female and 21 male subjects) using QCT...
February 10, 2018: Journal of Allergy and Clinical Immunology
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