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Effects of smoking cannabis on lung function

Expert Review of Respiratory Medicine , August 2011, Vol. 5, No. 4, Pages 537-547.

Corticosteroids in Respiratory Diseases in Children.

Authors: de Benedictis FM, Bush A Abstract We review recent advances in the use of corticosteroids in pediatric lung disease. They are frequently used, either systemically or by inhalation. Their mechanisms of action in pulmonary diseases are ill defined. Corticosteroids exert direct inhibitory effects on many inflammatory cells through genomic mechanisms. There is a time lag before clinical response, and the wash out of effects is also prolonged. Prompt relief in some conditions such as croup may be related to airway mucosal vasoconstriction through a nongenomic mechanism. Corticosteroids have proven beneficial roles in asthma, croup, allergic bronchopulmonary aspergillosis and subglottic hemangioma. In some conditions, such as bronchiolitis, cystic fibrosis and bronchopulmonary d...

Comprehensive care of the patient with idiopathic pulmonary fibrosis

Purpose of review: Recently, an expert committee endorsed by the American Thoracic Society, European Respiratory Society, Japanese Respiratory Society, and the Latin American Thoracic Society published an evidence-based guideline on the management of idiopathic pulmonary fibrosis (IPF). In the current document, we summarize and supplement this recent expert document and propose a comprehensive approach to the care and management of patients with IPF. Recent findings: We propose three pillars of care for the patient with IPF titled ‘disease-centered management’, ‘symptom-centered management’, and ‘education and self-management’. Disease-centered management involves both pharmacological and nonpharmacological approaches. Palliative care should be an integral and routine component of the care of patients with IPF. Education and self-management strengthens the provider–patient partnership by enabling patients to set realistic goals, remain in control of his or her care, and prepare for the future. Summary: The comprehensive care of the patient with IPF involves balancing the three pillars of disease-centered management, symptom-centered management, and patient education and self-management upon a solid foundation of provider–patient partnership. Constant reassessment of the individual patient's goals of care, based on their values and preferences, is essential to the constant recalibration of these various interventions.

Pulmonary Function Testing in Young Children

Abstract  
Pulmonary function testing (PFT) is of great importance in the evaluation and treatment of respiratory diseases. Spirometry is simple, noninvasive, and has been the most commonly used technique in cooperative children, obtaining reliable data in only a few minutes. The development of commercially available equipment as well as the simplification of previous techniques that now require minimal patient cooperation applied during tidal breathing have significantly stimulated the use of PFT in younger children. Tidal breathing techniques such as impulse oscillometry, gas dilution, and plethysmography have permitted previously unobtainable PFT in children 2 to 5 years of age. The purpose of this review is to help clinicians become familiar with available PFT techniques used in young children by discussing their general principles, clinical applications, and limitations.
  • Content Type Journal Article
  • Category Pediatric Allergy and Immunology (Jay M. Portnoy and Christina E. Ciaccio, Section Editors)
  • Pages 1-9
  • DOI 10.1007/s11882-011-0220-9
  • Authors
    • Hugo Escobar, Pediatric Pulmonary Department, The Children’s Mercy Hospitals and Clinics, University of Missouri-Kansas City, 2401 Gillham Road, Kansas City, MO 64108, USA
    • Terrence W. Carver, Pediatric Pulmonary Department, The Children’s Mercy Hospitals and Clinics, University of Missouri-Kansas City, 2401 Gillham Road, Kansas City, MO 64108, USA

Oral Food Challenges in Children: Review and Future Perspectives

Abstract  
Food allergy is a lifelong condition with no known treatment or cure. Allergy tests such as skin tests and blood tests are not always accurate when positive and are not necessarily diagnostic of a food allergy. A food allergy takes into consideration both the history of exposure and the testing. The food challenge is considered the diagnostic gold standard for food allergy. However, recent evidence suggests that not enough challenges are being performed. Several techniques exist with which clinicians can challenge patients. Providers who perform challenges should be familiar with assessing signs and symptoms of a potential reaction and must be prepared to treat anaphylaxis. The magnitude of the serum and skin tests may be of assistance in stratifying a patient’s risk of passing a challenge, and newer diagnostic tests may help better stratify such risk of based on particular epitope recognition.
  • Content Type Journal Article
  • Category Pediatric Allergy and Immunology (Jay M. Portnoy and Christina E. Ciaccio, Section Editors)
  • Pages 1-8
  • DOI 10.1007/s11882-011-0219-2
  • Authors
    • Matthew Greenhawt, Division of Allergy and Clinical Immunology, The University of Michigan Food Allergy Center, 24 Frank Lloyd Wright Drive, Lobby H 2100, Box 442, Ann Arbor, MI 48106, USA

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