Bronchiolitis in young female smokers

WOS: 000318327400012PubMed ID: 23352225Background: Smoking is a growing concern among young women. However, the pulmonary effects of smoking in young female smokers in their 20's are unknown. Objective: The purpose of this study was to determine whether young female smokers demonstrate smoking-related lung abnormalities such as bronchiolitis in their 20's. Methods: We recruited young females (20-30 yr) from Izmir, Turkey; 29 smokers and 31 life-time non-smokers. They were all asymptomatic. All subjects performed complete lung function measurements and underwent thoracic computed tomography (CT) scanning at suspended full inspiration using a Toshiba "Aquilion" multi-slice CT scanner. The CT images were analyzed using custom software (Emphylx-J) and published equations to calculate total lung volume, mean lung density, lung mass, and the extent of emphysema. CT images were also read semi-quantitatively for respiratory bronchiolitis and emphysema by 2 experienced chest radiologists. When there was substantial difference in scoring, a 3rd (independent) radiologist read the CT scans. Plasma biomarkers of smoking were also measured in these subjects. Results: Although none of the subjects demonstrated emphysema on CT images, 41% of smokers (compared with only 15% of non-smokers) had evidence for respiratory bronchiolitis (with a score of 2 or more; p = 0.0301). There was a significant relationship between pack-years of smoking and the severity of respiratory bronchiolitis in smokers. Plasma interleukin (IL)-6 levels were also higher in smokers than in non-smokers (p = 0.028). Quantitative analysis for emphysema or airways disease on CT scans did not reveal any significant differences in the two groups with the exception of lung mass, which was higher in the smokers than in nonsmokers. Lung function was similar between the two groups. Conclusion and clinical relevance: Young female smokers in their 20's and 30's demonstrate CT changes consistent with respiratory bronchiolitis and elevated plasma IL-6 levels. They also have "heavier" lungs compared with lifetime non-smokers. These data indicate that pathologic changes of smoking occur early in young female smokers in the absence of demonstrable airflow limitation or symptoms. Public health efforts to curb smoking in young women are clearly needed to reduce the burden of smoking related lung disease in women. (C) 2013 Elsevier Ltd. All rights reserved.Canadian Institutes of Health Research (ICEBERGS)Canadian Institutes of Health Research (CIHR); GlaxoSmithKline, Turkey; AstraZenecaAstraZeneca; GSK Clinical Scientist AwardThis study was funded jointly by a Team Grant in COPD from the Canadian Institutes of Health Research (ICEBERGS) and an educational grant from GlaxoSmithKline, Turkey.; DDS has received research funding from AstraZeneca and received honoraria for speaking engagements from GlaxoSmithKline, Merck, Takeda, and Grifols, He has also sat on advisory boards for Novartis, Merck and Takeda over the past 3 years.; HC received $4800 in the years 2008-2012 for serving on the steering committee for the ECLIPSE project for GSK. In addition HC was the co-investigator on two multi-center studies sponsored by GSK and has received travel expenses to attend meetings related to the project. HC has three contract service agreements with GSK to quantify the CT scans in subjects with COPD and a service agreement with Spiration Inc to measure changes in lung volume in subjects with severe emphysema. HC has received a fee for speaking at a conference and related travel expenses from AstraZeneca (Australia). HC was the recipient of a GSK Clinical Scientist Award in 2010

Clinical practice guideline for the management of infantile hemangiomas

Copyright © 2019 by the American Academy of Pediatrics. Infantile hemangiomas (IHs) occur in as many as 5% of infants, making them the most common benign tumor of infancy. Most IHs are small, innocuous, self-resolving, and require no treatment. However, because of their size or location, a significant minority of IHs are potentially problematic. These include IHs that may cause permanent scarring and disfigurement (eg, facial IHs), hepatic or airway IHs, and IHs with the potential for functional impairment (eg, periorbital IHs), ulceration (that may cause pain or scarring), and associated underlying abnormalities (eg, intracranial and aortic arch vascular abnormalities accompanying a large facial IH). This clinical practice guideline for the management of IHs emphasizes several key concepts. It defines those IHs that are potentially higher risk and should prompt concern, and emphasizes increased vigilance, consideration of active treatment and, when appropriate, specialty consultation. It discusses the specific growth characteristics of IHs, that is, that the most rapid and significant growth occurs between 1 and 3 months of age and that growth is completed by 5 months of age in most cases. Because many IHs leave behind permanent skin changes, there is a window of opportunity to treat higher-risk IHs and optimize outcomes. Early intervention and/or referral (ideally by 1 month of age) is recommended for infants who have potentially problematic IHs. When systemic treatment is indicated, propranolol is the drug of choice at a dose of 2 to 3 mg/kg per day. Treatment typically is continued for at least 6 months and often is maintained until 12 months of age (occasionally longer). Topical timolol may be used to treat select small, thin, superficial IHs. Surgery and/or laser treatment are most useful for the treatment of residual skin changes after involution and, less commonly, may be considered earlier to treat some IHs