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Murayama N, Doi S, Kameda M. 10-Year Follow-Up of Frequently Relapsed Chronic Eosinophilic Pneumonia Starting at 15 Years Old; Attempts to Treat with Inhaled Corticosteroid (A Case Report). AMERICAN JOURNAL OF CASE REPORTS 2019; 20:822-827. [PMID: 31182706 PMCID: PMC6581014 DOI: 10.12659/ajcr.915402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Patient: Female, 15 Final Diagnosis: Eosinophilic pneumonia Symptoms: Fever up • chest pain • general fatigue • dry cough Medication: Budesonide • Fulticasone Clinical Procedure: Inhaled steroids • systemic steroid Specialty: Immunology
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Affiliation(s)
- Norihide Murayama
- Department of Pediatrics, Murayama Pediatrics, Osaka City, Osaka, Japan
| | - Satoru Doi
- Department of Education, Shitennouji University, Osaka City, Osaka, Japan
| | - Makoto Kameda
- Department of Pediatrics, Osaka Habikino Medical Center, Osaka City, Osaka, Japan
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So JY, Lastra AC, Zhao H, Marchetti N, Criner GJ. Daily Peak Expiratory Flow Rate and Disease Instability in Chronic Obstructive Pulmonary Disease. CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2015; 3:398-405. [PMID: 28848862 DOI: 10.15326/jcopdf.3.1.2015.0142] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Rationale: Chronic obstructive pulmonary disease, (COPD) is a major cause of morbidity and mortality in the United States. Peak expiratory flow rate (PEFR) monitoring could provide a daily objective measurement of lung function in COPD patients at home. We hypothesized that individuals with greater variability in daily PEFR would signal an unstable patient population with worse outcomes. Methods: This was a retrospective analysis of prospectively collected data using an electronic diary to record daily PEFR and symptoms in severe and very severe COPD patients. Rates of PEFR change were used to characterize patients into stable and unstable groups determined by the distribution of slopes. Exacerbation-free days, time to first hospitalization, hospitalization rate, length of hospitalization, and all-cause mortality were assessed. Results: A total of 104 severe and very severe COPD patients met entry criteria, and were observed for 37,702 patient-days. There were no significant differences in baseline symptoms, demographics, forced expiratory volume in 1 second (FEV1) or comorbidities between stable versus unstable groups. The unstable group had 34.7 less exacerbation-free days and significantly shorter 6 minute walk distances (6MWD) (227.1 versus 270.7 meters, p=0.031), shorter time to first hospitalization (163 versus 286 days, p=0.017), more frequent hospitalizations (2.6 versus 1.7 per year, p=0.032) and higher all-cause mortality (10.8 versus 5.1%, p= 0.04). Conclusion: Patients with severe to very severe COPD with greater changes in PEFR have shorter 6MWD, reduced time to first hospitalization, more frequent hospitalizations, and higher all-cause mortality despite similar demographic, spirometric and comorbid parameters at baseline. Daily peak flow monitoring can be a useful tool in identifying COPD patients predisposed to worse outcomes.
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Affiliation(s)
- Jennifer Y So
- Division of Pulmonary and Critical Care Medicine, Temple University Hospital, Philadelphia, Pennsylvania
| | - Alejandra C Lastra
- Division of Pulmonary and Critical Care Medicine, Temple University Hospital, Philadelphia, Pennsylvania
| | - Huaqing Zhao
- Division of Pulmonary and Critical Care Medicine, Temple University Hospital, Philadelphia, Pennsylvania
| | - Nathaniel Marchetti
- Division of Pulmonary and Critical Care Medicine, Temple University Hospital, Philadelphia, Pennsylvania
| | - Gerard J Criner
- Division of Pulmonary and Critical Care Medicine, Temple University Hospital, Philadelphia, Pennsylvania
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3
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Kim KS, Won HR, Park CY, Hong JH, Lee JH, Lee KE, Cho HS, Kim HJ. Analyzing serum eosinophil cationic protein in the clinical assessment of chronic rhinosinusitis. Am J Rhinol Allergy 2013; 27:e75-80. [PMID: 23710948 DOI: 10.2500/ajra.2013.27.3901] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Eosinophil cationic protein (ECP) is a major granule-derived protein with cytotoxic activity found in eosinophils and has been known as a useful marker of allergic inflammation. In this study, we assessed the clinical significance of ECP in chronic inflammation of the nasal mucosa by evaluating the relationship between eosinophil activity and serum ECP concentration in a cohort of subjects with or without chronic rhinosinusitis (CRS) and allergic rhinitis (AR). METHODS We retrospectively reviewed the medical records of 492 subjects and analyzed eosinophil percentage in nasal smears, serum eosinophil counts, serum ECP concentrations, symptom scores, CT scores, the size of nasal polyp, and recurrence of CRS at follow-up. RESULTS Elevated serum ECP concentration was closely related with higher eosinophil expression in all subject's nasal smears and sera. CRS subjects without AR had a higher percentage of immune cells that were eosinophils compared with control subjects and it was similar to subjects' with AR only or with both CRS and AR. CRS subjects without AR also had significantly higher serum ECP concentrations and eosinophil counts compared with control subjects. Additionally, serum ECP concentration was significantly correlated with CT scores, symptom scores, polyp size, and recurrence rate in CRS subjects without AR. CONCLUSION Serum ECP concentration can be used as a marker of local and systemic eosinophil expression. We conjecture that although serum ECP elevation may not be specific in AR, analysis of serum ECP concentration could be particularly useful in estimating the progression and prognosis of CRS.
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Affiliation(s)
- Kyung Soo Kim
- Department of Otolaryngology and Head and Neck Surgery, Chung-Ang University, College of Medicine, Seoul, Korea
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4
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Asthma. PEDIATRIC ALLERGY, ASTHMA AND IMMUNOLOGY 2008. [PMCID: PMC7120610 DOI: 10.1007/978-3-540-33395-1_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Asthma has been recognized as a disease since the earliest times. In the Corpus Hippocraticum, Hippocrates used the term “ασθμα” to indicate any form of breathing difficulty manifesting itself by panting. Aretaeus of Cappadocia, a well-known Greek physician (second century A.D.), is credited with providing the first detailed description of an asthma attack [13], and to Celsus it was a disease with wheezing and noisy, violent breathing. In the history of Rome, we find many members of the Julio-Claudian family affected with probable atopic respiratory disorders: Caesar Augustus suffered from bronchoconstriction, seasonal rhinitis as well as a highly pruritic skin disease. Claudius suffered from rhinoconjunctivitis and Britannicus was allergic to horse dander [529]. Maimonides (1136–1204) warned that to neglect treatment of asthma could prove fatal, whereas until the 19th century, European scholars defined it as “nervous asthma,” a term that was given to mean a defect of conductivity of the ninth pair of cranial nerves.
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Abstract
Several methods are available for assessing drug effects on airway inflammation and the antiinflammatory effects of drugs for asthma. Cromolyn and theophylline are well-established drugs for the treatment of asthma, and each has antiinflammatory properties. Drugs in development include those aimed at inhibiting inflammatory mediators and immunoglobulin E function; clinical studies, however, have been conducted largely in patients with moderate to severe asthma.
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Affiliation(s)
- K V Blake
- Research Department, Nemours Children's Clinic, Jacksonville, Florida 32207, USA.
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Affiliation(s)
- C A Jones
- University of Southampton, United Kingdom.
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Holt PG, Sly PD. Prevention of adult asthma by early intervention during childhood: potential value of new generation immunomodulatory drugs. Thorax 2000; 55:700-3. [PMID: 10899250 PMCID: PMC1745827 DOI: 10.1136/thorax.55.8.700] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- P G Holt
- TVW Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, Western Australia 6872.
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8
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Abstract
Asthma is a chronic inflammatory disorder that can lead to progressive, potentially irreversible declines in lung function in some patients. Asthmatic inflammation develops when the sequential interaction of inflammatory cells with resident cells generates a cascade of events that contribute to the chronic inflammation and clinical manifestations associated with the disease, including further inflammation, airway smooth muscle spasm (bronchospasm), airway mucus secretion, airway edema and narrowing, and bronchial epithelial damage. Because of the chronic, progressive nature of asthmatic inflammation and the early age of onset, the ability to evaluate inflammation in children would be useful. Several procedures that quantify inflammatory mediators (in peripheral blood, induced sputum, bronchoalveolar lavage fluid, and bronchial biopsies) have shown potential usefulness in the evaluation of and the monitoring of disease severity in children (and, by extension, adults) with asthma. Further research needs to be devoted to the elucidation of when the inflammatory process starts and how it changes over time, to the determination of whether the inflammatory process is the same in all patients with wheezing, regardless of the stimulus, to the definition of the relationship between atopy and asthma, and to the establishment of the usefulness of testing for inflammatory markers to help identify individual asthmatic phenotypes, to evaluate disease severity, to measure therapeutic response, and/or to predict potential outcomes.
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Affiliation(s)
- R F Lemanske
- Departments of Pediatrics and Medicine, University of Wisconsin Medical School, Madison, WI, USA
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Affiliation(s)
- P G Holt
- TVW Telethon Institute for Child Health Research, Perth, Western Australia, Australia.
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10
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Abstract
Asthma in adults is generally recognized as a chronic inflammatory airway disease, although this association is less well established in childhood asthma. Thus, recent asthma guidelines have emphasized that asthma treatment should be directed toward the underlying inflammatory aspects of the disease. The prevalence of asthma and resultant hospitalizations and deaths have increased or remained stable over the past 10 years in the United States. In part, this appears to be caused by shortcomings of available antiasthma therapeutic agents. Because these trends are particularly troublesome in children and young adults, there is a need for effective anti-inflammatory therapies that are safe and tolerable. The leukotrienes are a family of lipid mediators that appear to play an important role in the symptomology and pathogenesis of asthma. The results of clinical trials in adults with asthma demonstrated that antileukotriene drugs such as zafirlukast, montelukast, and zileuton improve pulmonary function, decrease asthma symptoms, and decrease the concomitant use of other antiasthma drugs. Most antileukotriene agents are orally bioavailable and well tolerated, offering the potential for improved patient compliance. Montelukast and zafirlukast have received approval for use in pediatric asthma patients, and approval of zafirlukast in this patient population is pending.
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Affiliation(s)
- S C Weisberg
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
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Pelkonen AS, Suomalainen H, Hallman M, Turpeinen M. Peripheral blood lymphocyte subpopulations in schoolchildren born very preterm. Arch Dis Child Fetal Neonatal Ed 1999; 81:F188-93. [PMID: 10525021 PMCID: PMC1721001 DOI: 10.1136/fn.81.3.f188] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To investigate whether lymphocytes or serum inflammatory markers are associated with obstructive lung disease and bronchial lability in schoolchildren born very preterm. METHOD Lymphocyte subsets were studied in the peripheral venous blood of 29 such children (median age 8.8 years). Serum eosinophil cationic protein (ECP) and myeloperoxidase (MPO) concentrations and the association between them, lymphocyte subsets, and lung function were studied. Fourteen healthy children born at term, median age 9.1 years, served as controls. T lymphocytes (CD3), T lymphocyte subpopulations (CD4 and CD8), B lymphocytes (CD19), natural killer cells (CD16+56) and activation markers of T and B lymphocytes (CD23 and CD25) were determined using flow cytometry. Lung function was measured in all children both in the clinic and at home (Vitalograph Data Storage Spirometer). RESULTS Compared with the controls, schoolchildren born very preterm had significantly lower CD4(+) T cell percentages and CD4:CD8 ratios (p < 0.05 for both), whereas natural killer cell percentages and serum ECP values were significantly higher (p < 0. 05). The very preterm schoolchildren had significantly lower spirometric values than the control group (p < 0.05)-except forced vital capacity. When all the subjects were considered together, a weak, but significant, negative association was observed between the bronchial responsiveness in peak expiratory flow, after a beta(2) agonist during home monitoring, and the CD4(+) T cell percentage (r = -0.45; p = 0.008) and the CD4:CD8 ratio (r = -0.50; p = 0.003), indicating a relation between bronchial lability and imbalance of T cell subpopulations. CONCLUSIONS These results suggest that there is an inflammatory basis for lung function abnormalities in schoolchildren born very preterm.
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Affiliation(s)
- A S Pelkonen
- Department of Allergic Diseases, Helsinki University Central Hospital, Meilahdentie 2, POB 160 00029 Huch, Finland
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Affiliation(s)
- J E Gern
- Departments of Medicine and Pediatrics, University of Wisconsin Medical School, Madison, Wisconsin 53792, USA
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Matsuda K, Akasawa A, Capulong MCT, Iikura Y, Kato H, Saito H. Evaluation of factors that allow the clinician to taper inhaled corticosteroids in childhood asthma. Allergol Int 1999. [DOI: 10.1046/j.1440-1592.1999.00141.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Affiliation(s)
- P Jain
- Department of Pulmonary and Critical Care Medicine, The Cleveland Clinic Foundation, OH 44195, USA
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15
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Abstract
Bronchial asthma is an airway disorder associated with bronchial hyperresponsiveness, variable airflow obstruction and elevated levels of nitric oxide (NO) in exhaled air. The variables all reflect, in part, the underlying airway inflammation in this disease. To understand their interrelationships we have investigated the relationship between exhaled NO levels and clinicophysiological markers of asthma severity. Twenty-six steroid naive atopic asthmatics participated in the analysis. All were given diary cards and were asked to record their peak expiratory flow (PEF) rates twice daily together with their asthma symptom scores and beta-agonist use. Diary cards were collected 2 weeks later and measurements of exhaled NO levels, FEV1 and histamine bronchial hyperreactivity (PC20 histamine) were undertaken. Exhaled NO levels were significantly higher in our study population than in normal control subjects and correlated negatively with PC20 histamine (r = -0.51; P = 0.008) and positively with PEF diurnal variability (r = 0.58; P = 0.002), but not with symptom scores, beta-agonist use of FEV1 (%). We conclude that a significant relationship exists between exhaled NO levels and the two characteristic features and markers of asthma severity, namely bronchial hyperreactivity and PEF diurnal variability. The lack of correlation between symptom score and beta-agonist use, of FEV1 (%) predicted and exhaled NO suggests that these measures are reflective of differing aspects of asthma.
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Affiliation(s)
- M K al-Ali
- University Medicine, Southampton General Hospital, U.K
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