Asthma

A 38-year-old woman with a history of injection drug use presented with progressive pain in the left arm and neck and fever.

ABSTRACT: Patients who experience an acute myocardial infarction (MI) are at very high risk for recurrent cardiovascular events. Both site-supervised and home-based cardiac rehabilitation programs can effectively reduce all-cause and cardiovascular mortality. Start risk factor reduction as soon as possible; pharmacotherapy is best initiated while patients are still in the hospital. All patients who have had an MI should receive aspirin, an angiotensin-converting enzyme inhibitor, and a ß-blocker, unless these agents are contraindicated or are not tolerated. Prescribe aggressive lipid-lowering therapy to bring patients' low-density lipoprotein cholesterol levels to below 70 mg/dL. For smokers, quitting is the single most important change they can make to reduce future risk of MI.

Obesity is a well-known risk factor for many diseases. Now it looks like asthma can be added to the list. A meta-analysis that was conducted by Beuther and Sutherland indicated that being overweight is associated with a 50% increase in the incidence of asthma. The risk applies to both men and women.

Phytobezoars commonly develop in the distal small bowel, where the lumen is narrow. Prevalence is higher after partial gastric resection.

ROCHESTER, Minn. -- Asthma care remains focused primarily on the short-term chase of acute exacerbations rather than long-term control, researchers here said.

NEW YORK -- Eating too much bacon and sausage may increase the risk of chronic obstructive pulmonary disease, found researchers here.

NEW YORK -- Children with Helicobacter pylori infection have reduced risks of asthma and allergy, researchers here reported.

SEUOL, Korea -- The average body mass index in a group of children with otitis media with effusion was about 35% higher than among those with no history of ear infection, found researchers here.

DUBLIN -- Ireland's national ban on smoking in the workplace, including bars and restaurants, dramatically improved conditions for pub workers.

abstract: Subcutaneous allergen immunotherapy is clearly beneficial in the treatment of select patients with allergic rhinitis or asthma. However, this therapy is underused, partly because it requires administration in a medical facility. Sublingual immunotherapy (SLIT) may be a promising alternative; it appears to be associated with fewer adverse effects, which suggests that it might be administered at home. Currently, there is no FDA-approved formulation for SLIT in the United States. However, allergists are showing increased interest in this therapy, and an approved formulation may be available in the near future. A number of studies have shown the clinical efficacy of SLIT, but many questions remain unanswered, including the effective dose, optimal treatment schedules, and overall duration of treatment. (J Respir Dis. 2007;28(4):162-168)

A pruritic rash around the elbows; a soft, doughy papule; a slightlytender nodule with a keratotic core-do you recognize the disorderspictured here?

A middle-aged man hospitalized for intensive pulmonary toilet and topical and systemic treatment of a refractory skin disorder. Cough and moderate dyspnea with even mild exertion. Complains of scaling, uncomfortable dermopathy that he finds deeply cosmetically disfiguring and emotionally distressing.

LONDON -- On the eastern Mediterranean island of Crete, where olive oil is the primary source of fat, children with allergic rhinitis are uncommon, found a British team.

SOUTHAMPTON, England -- The research focus in asthma should shift back to conventional T-cells and away from the newly discovered invariant natural killer cells, according to investigators here.

DENVER, April 2 -- The occurrence rate of asthma increases by 50% in adults who are overweight or obese, according to a small meta-analysis.

A 65-year-old woman seeks evaluation of a tender, pruritic patchy rash on the trunk and extremities, as well as tender lips. Her symptoms began after she started taking a new NSAID for osteoarthritis. She has no known drug allergies and has not changed any other medications. The photographs were taken 2 days apart.

Allergic disorders are becoming more common. For example, about 20% of Americans have allergic rhinitis, which accounts for more than 10 million office visits each year. Most of these visits are to primary care clinicians.

UTRECHT, The Netherlands -- Lifeguards, swimming instructors, and other pool rats are likely to wind up with respiratory symptoms, according to researchers here.

HAMILTON, Ontario -- Adults with severe persistent asthma refractory to high-doses of drugs reacted well to radiofrequency warming, a procedure for opening airways called bronchial thermoplasty.

CLEVELAND -- Concerns that morphine or other opioids will cause respiratory depression when given to cancer patients for pain appear to be unfounded, investigators here found.

ROCHESTER, N.Y. -- Inadequate asthma control remains common among children, researchers here said.

CINCINNATI -- African-American children are particularly susceptible to exposure to second-hand tobacco smoke, according to researchers here.

SAN DIEGO -- Severe acute abdominal pain, which may recur with no obvious clinical explanation, could be due to hereditary angioedema, reported investigators here.

Managing Managed Care: Health Literacy, HIV, and Outcomes

Prompt recognition of poorly controlled asthma is one of the keys to avoiding asthma-related hospitalizations. Yet symptoms appear to be an unreliable indicator of the degree of airway obstruction. Even more sobering news comes from a pharmacy-based survey, which found that almost 70% of patients with poorly controlled asthma considered their asthma to be well controlled.

abstract: The mainstay of therapy for acute severe asthma includes ß2-agonists, anticholinergics, and corticosteroids. Other agents, such as leukotriene modifiers and magnesium sulfate, can be used in patients who have responded poorly to conventional therapy. Noninvasive positive pressure ventilation (NPPV) should be tried before intubation in alert, cooperative patients who have not improved with aggressive medical therapy. However, NPPV should not be attempted in patients who are rapidly deteriorating or in those who are somnolent or confused. Endotracheal intubation is recommended for airway protection or for patients who present with altered mental status or circulatory shock. Patients should be admitted to the ICU if they have difficulty in talking because of breathlessness, altered mental status, a forced expiratory volume in 1 second or peak expiratory flow rate of less than 25% of predicted, or a PaCO2 greater than 40 mm Hg after aggressive treatment in the emergency department. (J Respir Dis. 2007;28(3):113-117)

A 45-year-old man presented with food impactionof 3 hours' duration. He also complainedof dysphagia and chest pain. His historyincluded asthma during childhood and intermittentdysphagia for the past 3 years. Anupper endoscopy performed 2 years earlier showed noesophageal lesions.

SAN DIEGO -- For controlling asthma, an investigational oral anti-inflammatory drug with multiple actions, called MN-001, appears to be safe and effective, researchers reported here.

SAN DIEGO -- Allergic fungal sinusitis deserves a place of its own at the table of nasty chronic rhinosinusitis infections, researchers asserted here.

SAN DIEGO -- Public schools can be challenged learners in protecting children with severe food allergies, University of Michigan researchers reported here.