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THE BRONCHODILATION RESPONSE TO DEEP INSPIRATIONS IN ASTHMA IS DEPENDENT ON AIRWAY DISTENSIBILITY AND AIR TRAPPING.

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THE BRONCHODILATION RESPONSE TO DEEP INSPIRATIONS IN ASTHMA IS DEPENDENT ON AIRWAY DISTENSIBILITY AND AIR TRAPPING.

J Appl Physiol. 2010 Nov 11;

Authors: Pyrgos G, Scichilone N, Togias A, Brown RH

In healthy individuals, deep inspirations (DIs) have a potent bronchodilatory ability against methacholine (Mch)-induced bronchoconstriction. This is variably attenuated in asthma. We hypothesized that inability to bronchodilate with DIs is related to reduced airway distensibility. We examined the relationship between DI-induced bronchodilation and airway distensibility in 15 asthmatics with a wide range of baseline lung function (FEV(1) range: 60-99% predicted). After abstaining from DIs for 20 minutes, subjects received a single dose Mch challenge followed by DIs. The effectiveness of DIs was assessed by their ability to improve FEV(1). The same individuals had two sets of high-resolution computerized tomography (HRCT) scans, one at FRC and one at TLC. In each subject, the areas of 21 to 41 airways (0.8-6.8 mm in diameter at FRC) were matched and measured and airway distensibility (the increase in airway diameter from FRC to TLC) was calculated. The bronchodilatory ability of DIs was significantly lower in individuals with FEV(1) <75%, compared to those with ≥ 75% predicted (15±11% vs. 46±9%, p=0.04), and strongly correlated with airway distensibility (r= 0.57, p=0.03), but also with RV/TLC (r= -0.63, p=0.01). In multiple regression, only RV/TLC was a significant determinant of DI-induced bronchodilation. These relationships were lost when the airways were examined after maximal bronchodilation with albuterol. Our data indicate that the loss of the bronchodilatory effect of deep inspiration in asthma is related to the ability to distend the airways with lung inflation, which is, in turn, related to the extent of air trapping and ASM tone. These relationships only exist in the presence of airway tone indicating that structural changes in the conducting airways visualized by HRCT do not play a pivotal role.

PMID: 21071596 [PubMed - as supplied by publisher]

Prognostic Model to Predict Outcomes in Non-Small Cell Lung Cancer Patients with Erlotinib as Salvage Treatment.

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Prognostic Model to Predict Outcomes in Non-Small Cell Lung Cancer Patients with Erlotinib as Salvage Treatment.

Oncology. 2010 Nov 12;79(1-2):78-84

Authors: Kim ST, Lee J, Sun JM, Park YH, Ahn JS, Park K, Ahn MJ

Purpose: To devise a prognostic model based on clinical parameters for non-small cell lung cancer (NSCLC) patients treated with erlotinib as a salvage therapy. Patients and Methods: Between July 2006 and September 2008, two hundred fifty-seven metastatic/relapsed NSCLC patients who had been treated with erlotinib as a salvage therapy were analyzed retrospectively. Results: For the 257 patients, the median overall survival (OS) and progression-free survival (PFS) with erlotinib treatment were 12.4 and 2.8 months. Multivariate analysis showed that an ECOG performance status of 2 or more, an elevated serum LDH level, and the absence of skin rash were independent adverse prognostic factors for OS and that the presence of intra-abdominal metastasis, 2 or more prior chemotherapy regimens, and the absence of skin rash were prognostic factors for PFS. Patients were categorized into the following 4 prognosis groups on the basis of each adverse prognostic factor: good, intermediate, poor, and very poor prognosis. The median OS times for the good, intermediate, poor, and very poor prognosis groups were 22.0, 9.3, 5.4, and 2.7 months (p < 0.001) and the median PFS times were 6.5, 3.0, 1.2, and 0.9 months (p < 0.001). Conclusion: This prognostic model based on clinical parameters would be useful to identify patients who might be most likely to benefit from erlotinib therapy in clinical practice.

PMID: 21071994 [PubMed - as supplied by publisher]

Diagnosis of Allergy and Asthma in Childhood

Abstract  
Childhood asthma is a widespread health problem because of its epidemic prevalence, as asthma affects more than 300 million people worldwide. Results from cross-sectional and cohort studies show that asthma starts in childhood in a large proportion of cases. A proper diagnosis is easier to make in adults and school-age children, as permanent changes in lung development, the strong impact of environmental factors on the airways, the immunologic maturity process, and the use of some diagnostic tools make asthma more difficult to diagnose in preschool children. This period of a child’s life is an interesting challenge for pediatricians and specialists. The aim of the present review is to analyze the current knowledge regarding making an early and accurate asthma diagnosis and therefore deciding on the correct treatment to gain control over asthma symptoms and minimize health risks.
  • Content Type Journal Article
  • DOI 10.1007/s11882-010-0156-5
  • Authors
    • Carlos E. Baena-Cagnani, CIMER (Centro de Investigación en Medicina Respiratoria), Catholic University of Córdoba, Santa Rosa 381, X 5000 ESG, Córdoba, Argentina
    • Héctor A. Badellino, CIMER (Centro de Investigación en Medicina Respiratoria), Catholic University of Córdoba, Santa Rosa 381, X 5000 ESG, Córdoba, Argentina

Epicutaneous Immunotherapy in Grass-Induced Allergic Rhinitis

Epicutaneous Immunotherapy in Grass-Induced Allergic Rhinitis

  • Content Type Journal Article
  • DOI 10.1007/s11882-010-0165-4
  • Authors
    • John J. Oppenheimer, Pulmonary and Allergy Associates, New Jersey Medical School, 8 Saddle Road, Cedar Knolls, NJ 07927, USA

Interstitial lung diseases in children.

Interstitial lung disease (ILD) in infants and children comprises a large spectrum of rare respiratory disorders that are mostly chronic and associated with high morbidity and mortality.

These disorders are characterized by inflammatory and fibrotic changes that affect alveolar walls. Typical features of ILD include dyspnea, diffuse infiltrates on chest radiographs, and abnormal pulmonary function tests with restrictive ventilatory defect and/or impaired gas exchange. Many pathological situations can impair gas exchange and, therefore, may contribute to progressive lung damage and ILD. Consequently, diagnosis approach needs to be structured with a clinical evaluation requiring a careful history paying attention to exposures and systemic diseases. Several classifications for ILD have been proposed but none is entirely satisfactory especially in children. The present article reviews current concepts of pathophysiological mechanisms, etiology and diagnostic approaches, as well as therapeutic strategies. The following diagnostic grouping is used to discuss the various causes of pediatric ILD: 1) exposure-related ILD; 2) systemic disease-associated ILD; 3) alveolar structure disorder-associated ILD; and 4) ILD specific to infancy. Therapeutic options include mainly anti-inflammatory, immunosuppressive, and/or anti-fibrotic drugs.

The outcome is highly variable with a mortality rate around 15%. An overall favorable response to corticosteroid therapy is observed in around 50% of cases, often associated with sequelae such as limited exercise tolerance or the need for long-term oxygen therapy.

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