The identification of eosinophilic gastroenteritis in prednisone-dependent eosinophilic bronchitis and asthma.

This case reports the unique association of eosinophilic gastrointestinal disease with eosinophilic bronchitis, asthma and chronic rhinosinusitis and some features of lymphocytic hypereosinophilic syndrome, describes a diagnostic protocol for patients with asthma and persistent eosinophilic bronchitis, and suggests that the use of a novel EPX-mAb provides a reliable method to identify eosinophilic inflammation.

Reproducibility, validity, and responsiveness of cell counts in blown nasal secretions.

Cell counts in nasal secretions are not used in routine clinical practice to decide on anti-inflammatory or antimicrobial therapy. This study investigated the reproducibility, reliability (validity), and responsiveness of cell counts in blown nasal secretions with a view to implementing this in routine clinical practice. Nasal secretions were obtained from 19 subjects with allergic rhinitis on 3 days in random order (each separated by 1-2 days) by spontaneously blowing their noses (on 2 days) and by a nasal lavage by the modified Grunberg method on the 3rd day.

Paranasal sinus disease and sputum eosinophilia in prednisone-dependent asthma.

Objectives: to investigate the extent and characteristics of paranasal sinus abnormalities (anatomic and mucosal) on computed tomographic (CT) sinus scans and to determine whether there is a relationship between these findings and eosinophilic airway inflammation in patients with prednisone-dependent asthma.

Methods: we conducted an observational survey of 15 prednisone-dependent asthmatic patients with respect to measures of airway inflammation and CT sinus scans. The pathologic changes on the CT scans were scored using the Lund-Mackay and JAMA staging systems, and several paranasal bony anatomic variations were recorded.

Early interventions with inhaled corticosteroids in asthma: benefits and risks.

Purpose Of Review: the present review examines the effects of early intervention with inhaled corticosteroids (ICSs) on clinical efficacy and natural history of asthma based on two recent clinical trials: the Inhaled Steroid Treatment as Regular Therapy in Early Asthma (START) and Prevention of Early Asthma in Kids (PEAK) trials, and a comparison of the effect of regular vs. intermittent therapy based on the Improving Asthma Control Trial (IMPACT).

Recent Findings: in most patients, both adults and children, who have a new diagnosis of asthma and whose symptoms are mild but persistent, treatment with ICS should be recommended as soon as the diagnosis is made.

Atmospheric remote sensing to detect effects of temperature inversions on sputum cell counts in airway diseases.

Temperature inversions result in the accumulation of air pollution, often to levels exceeding air quality criteria. The respiratory response may be detectable in sputum cell counts. This study investigates the effect of boundary layer temperature inversions on sputum cell counts.

Measuring bronchitis in airway diseases: clinical implementation and application: Airway hyperresponsiveness in asthma: its measurement and clinical significance.

Airway inflammation is fundamental to the cause and persistence of asthma and other airway conditions. It contributes to symptoms, variable airflow limitation, airway hyperresponsiveness, and the structural changes (remodeling) associated with asthma. However, the presence and type of airway inflammation can be difficult to detect clinically, delaying the introduction of appropriate treatment.

Airway responsiveness to indirect challenges in COPD.

Patients with chronic obstructive pulmonary disease (COPD) demonstrate airway hyperresponsiveness to a number of indirect stimuli. Hyperresponsiveness to cold air hyperventilation, exercise, and drugs like propranalol and methoxamine seem to be able to distinguish patients with COPD from those with asthma, whereas hyperresponsiveness to stimuli like adenosine 5-monophosphate (AMP) and hypertonic saline seem unable to do so. The relationship of airway responsiveness to indirect stimuli and airway inflammation has received little study.

Clinical equivalence testing of inhaled bronchodilators.

There are no standardized methods to demonstrate in-vivo bioequivalence of inhaled bronchodilators. The most practical method of showing therapeutic equivalence in vivo is by estimating their relative potencies (RP) in clinical efficacy studies. The RP of bronchodilators may be estimated by comparing either their bronchodilator or bronchoprotective properties.

Mepolizumab for prednisone-dependent asthma with sputum eosinophilia.

Background: Eosinophilic inflammation, which may be a consequence of interleukin-5 action, is a characteristic feature of some forms of asthma. However, in three previous clinical trials involving patients with asthma, blockade of this cytokine did not result in a significant improvement in outcomes. We studied the prednisone-sparing effect of mepolizumab, a monoclonal antibody against interleukin-5, in a rare subgroup of patients who have sputum eosinophilia and airway symptoms despite continued treatment with prednisone.

Antiinflammatory effects of long-acting beta2-agonists in patients with asthma: a systematic review and metaanalysis.

Background: Long-acting beta(2)-agonists (LABAs) are recommended as add-on therapy to antiinflammatory treatment in patients with chronic persistent asthma. Results from individual studies evaluating the in vivo antiinflammatory effect of LABAs are conflicting. The purpose of this metaanalysis was to determine whether LABAs have an in vivo antiinflammatory effect compared to placebo and whether the addition of a LABA to therapy with inhaled corticosteroids (ICSs) has a synergistic or additive antiinflammatory effect.

The safety of formoterol among patients with asthma using inhaled corticosteroids. Systematic review and meta-analysis.

Introduction: It has been postulated that inhaled long acting beta-agonists (LABAs) when used as monotherapy in asthma may increase the incidence of asthma related deaths, intubations and hospitalizations, but concomitant use of inhaled corticosteroids (ICS) may modify this effect.

Objectives: To assess the safety of formoterol in patients with asthma using ICS.

Patients And Methods: We conducted a systematic review and meta-analysis of parallel group, blinded, randomized controlled trials with at least 12 weeks of treatment examining the impact of twice a day formoterol on asthma-related and total morbidity and mortality in patients concurrently using ICS.

Cost analysis of monitoring asthma treatment using sputum cell counts.

Background: In a four-centre trial, the use of sputum cell counts (sputum strategy [SS]) to guide treatment had resulted in fewer and less severe exacerbations without the need for a higher corticosteroid dose, compared with the use of symptoms and spirometry (clinical strategy [CS]). objective: To compare the cost of the SS with the CS in the treatment of patients with moderate to severe asthma.

Methods: In 39 patients (19 in the SS, 20 in the CS) from one of the centres, the cost (third-party payer) of the two treatment strategies was compared.

LXR-induced reverse cholesterol transport in human airway smooth muscle is mediated exclusively by ABCA1.

The association of hypercholesterolemia and obesity with airway hyperresponsiveness has drawn increasing attention to the potential role of cholesterol and lipid homeostasis in lung physiology and in chronic pulmonary diseases such as asthma. We have recently shown that activation of the nuclear hormone receptor liver X receptor (LXR) stimulates cholesterol efflux in human airway smooth muscle (hASM) cells and induces expression of the ATP-binding cassette (ABC) transporters ABCA1 and ABCG1, members of a family of proteins that mediate reverse cholesterol and phospholipid transport. We show here that ABCA1 is responsible for all LXR-mediated cholesterol and phospholipid efflux to both apolipoprotein AI and high-density lipoprotein acceptors.

Asthma management by monitoring sputum neutrophil count.

We report the utility of quantitative cell counts in sputum in monitoring therapy of a patient with poorly controlled asthma. Recurrent neutrophilic bronchitis without an eosinophilic bronchitis led to the identification of Chlamydophila pneumoniae as the cause of bronchitis and asthma exacerbation. Serial examination of blood and sputum by polymerase chain reaction for C pneumoniae helped to prevent exacerbations by prophylactic antibiotic therapy, reduce the dose of prednisone and inhaled corticosteroids, and improve asthma control.

The safety of long-acting beta-agonists among patients with asthma using inhaled corticosteroids: systematic review and metaanalysis.

Rationale: Inhaled long-acting beta-agonists (LABAs), when used as monotherapy in asthma, may increase asthma-related hospitalizations, life threatening events requiring intubation/mechanical ventilation, and asthma-related deaths, but concomitant use of inhaled corticosteroids (ICS) may modify this effect.

Objectives: To determine the safety of long-acting beta-agonists among patients with asthma using corticosteroids.

Methods: We conducted a systematic review and metaanalysis of parallel-group, blinded, randomized, controlled trials with at least 12 weeks of treatment addressing the impact of LABA on asthma-related and total morbidity and mortality in patients concomitantly using ICS.

Does early intervention with inhaled corticosteroids alter the natural history of mild persistent asthma?

In most patients, both adults and children, who have a new diagnosis of asthma and whose symptoms are mild but persistent, treatment with inhaled corticosteroids (ICS) should be recommended as soon as the diagnosis is made. This is a cost-effective and safe treatment. Patients should be cautioned that their asthma will not be cured with short-term treatment and that their symptoms may recur and their lung function may decline again if treatment is discontinued.

A cumulative dose study of levalbuterol and racemic albuterol administered by hydrofluoroalkane-134a metered-dose inhaler in asthmatic subjects.

Background: The short-acting beta(2)-agonists levalbuterol and racemic albuterol are available for administration through a hydrofluoroalkane-134a (HFA) metered-dose inhaler (MDI).

Objective: This study compared the short-term safety and efficacy of cumulative doses of levalbuterol HFA MDI and racemic albuterol HFA MDI in asthmatic subjects.

Methods: This was a randomized, modified-blind, active-controlled, multicenter, 2-way crossover study.

The effects of leptin on airway smooth muscle responses.

Obesity is associated with asthma and airway hyperresponsiveness. Leptin modulates some of the proinflammatory effects observed in obesity. The objective of this study was to determine the effects of leptin on airway smooth muscle responses.

Myclonic seizures in a young girl with Fishers variant of Guillain-Barre syndrome.

A 10-year-old girl with Fischer`s variant of acute Guillain-Barre syndrome is described. She had predominantly sensory involvement with autonomic dysfunction, ophthalmoplegia and myoclonic jerks. Myoclonus persisted for 2 weeks and the pupillary involvement was evident even after 2 months.

Accidental tricyclic antidepressant poisoning in a 2 year-old boy.

We present a 2-year old boy with accidental ingestion of a tricyclic antidepressant and outline the clinical features, management and prevention. Despite ingesting a high dose of amitriptyline (20mg/kg) and showing serum levels above the toxic range (1380 ng/ml), our patient did not develop any life threatening complications. Gastric lavage followed by instillation of activated charcoal, repeated at 6 hours, along with supportive measures led to complete recovery in 48 hours.

Bonding agent is a decisive factor in determining the marginal leakage of dental composites subjected to thermal cycling: an in vitro study.

The marginal leakage at the dentine/composite interface in Class II composite restorations subjected to thermal cycling has been effectively evaluated using the silver staining technique. The presence of a bonding agent at the dentine/composite interface is found to improve adhesion. Scanning electron and optical microscopic observations of sectioned specimens reveal that applying a second coat of bonding agent on the dentinal surface helps in reducing microleakage compared to a single coat application, in all three radiopaque composite/bonding agent systems studied (Z100/Single Bond, Spectrum TPH/Prime & Bond 2.