Asthma

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.

SAN DIEGO -- Children with allergies to eggs can lose their sensitivity with the help of a little powdered egg and an oral desensitization regimen, according to Japanese researchers.

SAN DIEGO -- City-dwelling children with asthma may miss out on allergy screening or education about avoidance of household allergens, reported New York investigators.

SAN DIEGO -- Five of seven children with severe peanut allergy were able, after two years of oral immunotherapy, to tolerate a dose of 7.8 grams of peanut flour, equivalent to eating more than 13 peanuts.

SAN DIEGO -- It may be possible to predict which children with peanut allergies will eventually outgrow them and become goober tolerant, according to Australian investigators.

SAN DIEGO -- A wheezing illness before the age of three years signals the likelihood of asthma by age six, and frequent rhinoviral infections in infancy may have something to do with it, according to investigators here.

NASHVILLE, Tenn. -- In a year-long study, more than one in four children admitted to the hospital with acute respiratory symptoms had a rhinovirus infection, according to researchers here.

ROCKVILLE, Md. -- Anaphylaxis reports associated with the asthma drug omalizumab (Xolair) led the FDA today to order Genentech to add a black box warning to the agent's label.

MELBOURNE, Australia -- For children with intermittent asthma, a short course of Singulair (montelukast), a leukotriene antagonist, given at the first sign of an episode may reduce acute care visits, reported Australian investigators.

ST. LOUIS -- A live attenuated flu vaccine -- administered in a nasal spray -- outperformed the traditional inactivated vaccine in a large study of children from six months to five years old.

NEW YORK -- Low birth weight and child abuse combine synergistically to increase the later risks of depression by 10-fold and social dysfunction by nearly ninefold, researchers here said.

OAKLAND, Calif. -- Early signs of coronary atherosclerosis -- but only in women -- appear associated with a gene variant also linked to asthma.

Results of a large prospective study

A 69-year-old man with a history of atrial fibrillation, pulmonary embolism, asthma, and obstructive sleep apnea presented to the emergency department for evaluation of dyspnea and light-headedness. He had been treated for paroxysmal atrial fibrillation over the past 5 years; fairly good control had been achieved with metoprolol and amiodarone. However, over the past several months, he had been experiencing intermittent episodes of atrial fibrillation.

The initial assessment of acute severe asthma includes confirmation of the diagnosis and rapid assessment of mental status and degree of respiratory distress. The severity of airflow obstruction is best determined by forced expiratory volume in 1 second or peak expiratory flow rate. While inhaled ß2-agonists are the initial therapy, the combination of ipratropium and a ß2-agonist can enhance results in some patients. There also is evidence that inhaled corticosteroids can lead to a more rapid improvement in pulmonary function. (J Respir Dis. 2007;28(2):57-64)

LOS ANGELES -- Freeway traffic pollution can retard lung development of children whose homes are not far from the side of the road, researchers here reported.

Explain to interested patients that inhaled corticosteroids are known to be an effective therapy for persistent asthma, but some parents worry about their side-effects in children, especially on growth.

BUENOS AIRES -- Patients with relapsing-remitting multiple sclerosis who also had parasitic worm infections had significantly better clinical courses than non-infected MS patients, investigators here found on a small study.