The authors results suggest that, when combined to a beta–lactam, levofloxacin is associated with lower mortality than ofloxacin or ciprofloxacin in severe pneumococcal community–acquired pneumonia.
In smokers, interstitial lung abnormalities — which were present on about 1 of every 12 high–resolution computed tomographic scans — were associated with reduced total lung capacity and a lesser amount of emphysema.
A 64–year–old woman who has never smoked receives the diagnosis of stage I adenocarcinoma of the lung and undergoes right upper lobectomy. One year later, bone and liver metastases develop. She is treated with carboplatin, paclitaxel, and bevacizumab, but progressive bone metastases are noted after 6 weeks of therapy. An oncologist recommends the initiation of erlotinib therapy.
Asthma and COPD have a high personal, societal, and economic impact. Both diseases are characterized by airway obstruction and an inflammatory process.
The inflammatory process affects the whole respiratory tract, from central to peripheral airways that are <2 mm in internal diameter, the so-called small airways. There is an increased interest in small airway disease, and some new insights have been gained about the contribution of these small airways to the clinical expression of asthma and COPD, as reviewed in this article.
Newly developed devices enable drugs to target the small airways, and this may have implications for treatment of patients with asthma, particularly those not responding to large-particle inhaled corticosteroids or those with uncontrollable asthma. The first studies in COPD are promising, and results from new studies are eagerly awaited.
Suspected allergic reactions to drugs and biological substances (anti-infectious drugs and antipyretics, non opioid analgesics and nonsteroidal anti-inflammatory drugs especially) are reported in 5 to 12% of children. Most frequent reactions are morbilliform/maculopapular rashes, urticaria and angioedema. Other cutaneous and respiratory reactions, and severe allergic and non-allergic anaphylactic reactions are rare.
The results of studies based on allergological tests and/or microbiological/serological tests strongly suggest that, except for a few types of reactions (anaphylactic and/or immediate reactions, potentially harmful toxidermias) and for very specific drugs (i.e. latex and myorelaxants), most reactions to commonly used drugs and biological substances in children do not result from drug hypersensitivity, but are rather a consequence of the infectious and/or inflammatory diseases for which the drugs have been prescribed.
Non-immediate reactions may also result from complex interactions between drugs, immune system and "danger signals" provided or induced by infectious and/or inflammatory diseases. Diagnosis is based above all on a detailed analysis of clinical history, skin tests (if validated), and challenge tests (if indicated). At present, the diagnostic and predictive values of in vitro tests exploring immediate (specific IgE determination, histamine and leukotriene release tests, basophil activation test) and non-immediate type (lymphocyte activation tests, and cytokine assays in the supernatant of activated blood mononuclear cells) of drug hypersensitivity are not validated.