Asthma

BETHESDA, Md. -- Emphasizing that asthma affects different patients in different ways, the National Asthma Education and Prevention Program has issued new evidence-based guidelines on the disease.

COLUMBUS, Ohio -- Spirometry can help emergency departments distinguish between the wheezing of acute asthma in adolescents and vocal cord dysfunction, found investigators here.

LOS ANGELES -- Traffic-related air pollution increases asthma risk among children with genetic variants that affect the lungs' ability to clear toxins, researchers found.

BARCELONA, Spain -- Nurses develop occupational asthma at a rate that is more than double that of the general population, investigators in a multinational study have found.

SALT LAKE CITY -- Corticosteroids appear to be ineffective against first episode bronchiolitis in infants, despite frequent emergency room use, researchers said.

CHICAGO -- Medicare patients who couldn't read a physician's instructions, or who didn't understand what they read had a higher mortality rate than patients with adequate reading skills.

BOSTON -- A lack of fruit and fish in teenagers' diets may keep them from attaining full lung capacity and set them up for later respiratory problems, researchers here said.

LONDON, July 2 -- Cats may trigger an asthmatic airway response even in patients not specifically allergic to cat dander, researchers found.

The risks of occupational asthma have been established in a number of groups, such as farmers and workers who are exposed to certain chemicals, such as isocyanates. The results of a study conducted by Delclos and associates provide insight into the risks of asthma in healthcare workers. The bottom line: the risk of asthma is increased about 2-fold in persons whose tasks involve instrument cleaning and disinfection, use of general cleaning products, and administration of aerosolized medications.

Unilateral cystic lung anomalies are uncommon. We report a case of placental transmogrification of the lung in an adult, a condition with a peculiar histological pattern characterized by formation of placental, villus-like structures in the lung parenchyma.

Clinical Images to Help You Hone Your Diagnoses

LONDON -- A program of breathing and relaxation exercises known as the Papworth method eases the symptoms of asthma significantly -- largely without change in underlying lung function, researchers here said.

DUNEDIN, New Zealand -- Widespread systemic inflammation may be the missing link that explains why reduced lung function leads to heart disease, researchers here said.

SAINT-MAX, France -- Steroids and other performance-enhancing agents appear to be creeping into use by ever-younger populations -- even junior high students, researchers found.

WINNIPEG, Manitoba -- Children who are given antibiotics during the first year of life may be at significantly greater risk of developing asthma, researchers here found.

abstract: In the treatment of certain allergies, sublingual immunotherapy (SLIT) may represent an attractive alternative to subcutaneous immunotherapy (SCIT) because of its lower risk of systemic reactions. The most common adverse reactions are local symptoms, such as oral "itchiness." GI complaints, rhinoconjunctivitis, urticaria, and asthma are uncommon reactions to this therapy, and no fatalities have been reported. In contrast to SCIT, accelerated induction schedules for SLIT do not appear to be associated with an increased risk of systemic reactions. SLIT may present an opportunity for broadening the use of immunotherapy by extending it to patients who are not candidates for SCIT because they dislike injections, find the frequent visits to the physician's office inconvenient, or are concerned with the safety of SCIT. The optimal effective dose and dosing schedule need to be established before a cost-benefit analysis can be performed. (J Respir Dis. 2007;28(6):237-243)

Bronchial thermoplasty is a procedure designed to reduce airway smooth muscle mass and, as a result, reduce bronchoconstriction in persons with asthma. In this procedure, radiofrequency current is applied to the walls of the central airways during a series of bronchoscopies. The results of a randomized controlled study conducted in 11 centers in 4 countries suggest that this intervention is beneficial.

SAN FRANCISCO -- The electronic nose, already proficient at sniffing out bombs and optimizing coffee roasting, may become a one-stop diagnostic tool for asthma.

SAN FRANCISCO -- Some children, even if they have only mild to moderate asthma, may not get full symptom control despite consistent inhaled corticosteroid use, researchers have found.

SAN FRANCISCO -- Obesity makes asthma not only more common but worse, researchers reported here.

SAN FRANCISCO -- Nebulized formoterol (Perforomist) appears to treat chronic obstructive pulmonary disease as effectively as the dry-powder formulation (Foradil), researchers said here.

WINSTON-SALEM, N.C. -- For patients with mild persistent asthma, treatment options appear to have widened, according to two randomized trials.

ROTTERDAM, The Netherlands -- Through age five, children born at full term but with a low birth weight were more likely to have respiratory symptoms, but not asthma, researchers here reported.

BOSTON -- The so-called Mediterranean diet -- high in fruits, vegetables, fish, and whole grains -- is associated with a 50% reduction in the risk of chronic obstructive pulmonary disease, according to researchers here.

NEW YORK -- World Trade Center rescue workers exposed to airborne debris in the aftermath of the Sept. 11, 2001, attacks are at an increased risk for pulmonary sarcoidosis or a related disorder, investigators here have found.

DETROIT -- Asthma symptom control for urban African-American teens appears to improve via an Internet-based program tailored for them specifically, researchers here found.

Nonadherence with asthma controller medication is a common problem that increases the risk of asthma-related hospitalizations and emergency department visits. Although strategies to improve adherence have often been unsuccessful, it is clear that engaging patients in asthma self-management is one of the keys.

abstract: Proper assessment of the child's readiness for extubation and preparation for extubation are essential to minimize the need for reintubation and to maximize the child's safety in the periextubation period. Readiness for extubation requires that the child have adequate respiratory drive, the ability to maintain a patent airway, adequate oxygenation, and ability to ventilate spontaneously. Respiratory drive can be assessed by decreasing the ventilator settings to a minimal level and observing the child's respiratory effort and respiration rate. Evidence of increased work of breathing, such as tachypnea, retractions, and nasal flaring, suggests that the child may not be ready for extubation. If stridor and respiratory distress develop after the endotracheal tube is removed, nebulized racemic epinephrine is often quite effective; in addition, intravenous corticosteroids should be administered for 24 hours to help decrease the edema more quickly. (J Respir Dis. 2007;28(5):203-207)

A 33-year-old woman with a history of severe asthma requiring multiple intubations was brought to the emergency department. She had completed a 14-day course of prednisone 3 days earlier. Since then, she had had increasing dyspnea that acutely worsened after she used her albuterol nebulizer that morning. Her other asthma medications were theophylline and fluticasone. Her history included one episode of bilateral pneumothoraces secondary to barotrauma, which required chest tube insertion.

A 38-year-old woman with a history of injection drug use presented with progressive pain in the left arm and neck and fever (temperature, up to 38.8°C [102°F]) of 9 days' duration. Physical findings included subcutaneous crepitus, erythema, and swelling of the left arm, chest, and neck. White blood cell count was 27,000/µL with 91% neutrophils. Chest radiographs showed gas in the subcutaneous and soft tissue of the neck, arm, and chest . Necrotizing fasciitis was suspected.