Mepolizumab: a new drug in asthma armamentorium

Bronchial asthma is a syndrome characterized by airflow obstruction that varies markedly, both spontaneously and with treatment. The current therapy for asthma includes either inhaled corticosteroids alone or in combinations with inhaled bronchodilators with other controller options being theophyllines, leukotriene antagonists and systemic corticosteroids. In step V of Global Initiative for Asthma (GINA) management guidelines Anti Ig E, Omalizumab is recommended in selected patients when everything fails. But still some unmet need is felt in the form of refractory asthma. Mepolizumab, an IL-5 antagonist has been developed in this regard and has been approved by FDA on Nov 4, 2015 followed by European commission on Dec 02, 2015 in view of good results based on clinical trials conducted by GlaxoSmithKline a multi-centre, open-label long-term safety study of 100 milligram (mg) mepolizumab administered subcutaneously (SC) every 4 weeks for 12 months in addition to standard of care in subjects who have severe, refractory asthma and a history of eosinophilic inflammation. This article covers the review of mepolizumab with its advantages in refractory bronchial asthma

Clinicodemographic, radiological, and immunological profiles of allergic bronchopulmonary aspergillosis in a tertiary care institute in Eastern India

Background: Allergic bronchopulmonary aspergillosis (ABPA) is a type of hypersensitivity reaction to mold Aspergillus fumigatus, especially common in patients with bronchial asthma. However, systemic data regarding the clinicodemographic, radiological, and immunological profiles of patients is sparse, particularly from the eastern India.Methods: This is a prospective observational study done over a year, from January 2021 to December 2021, in patients visiting the pulmonary medicine outpatient department (OPD) with symptoms similar to ABPA. Following the clinical examination, routine blood investigations, serum total immunoglobulin E (IgE) test, Aspergillus-specific IgE test, spirometry, and chest radiology (chest X-ray/high resolution CT scan) were done. ABPA was diagnosed using the 2013 ISHAM-ABPA working group criteria. Data were analyzed using statistical package for the social sciences (SPSS) software version 2021 against different categories of eosinophil count.Results: A total of 99 patients, 74 male and 25 female, were diagnosed with ABPA. The mean age±standard deviation (SD) was 37.66±15.411. Most of the patients (93) were asthmatic. Chest radiology was normal in 52.5% of the cases. The absolute eosinophil count (mean±SD) was 3963.61±5333.363. The mean±SD serum IgE and Aspergillus-specific IgE levels were 8061.07±8374.274 and 7.5826±12.693, respectively.Conclusions: There was no significant association between lung function abnormalities and eosinophil count. Serology variant (ABPA-S) was the most common finding among ABPA patients. A high eosinophil count was associated with a high incidence of bronchiectasis and hyper attenuated mucus (HAM), although the severity of bronchiectasis was not directly related to a higher peripheral eosinophil count. There may be some correlation between the peripheral eosinophil count and the total IgE but not between the peripheral eosinophil count and the Aspergillus-specific IgE

Mepolizumab: a new drug in asthma armamentorium

Bronchial asthma is a syndrome characterized by airflow obstruction that varies markedly, both spontaneously and with treatment. The current therapy for asthma includes either inhaled corticosteroids alone or in combinations with inhaled bronchodilators with other controller options being theophyllines, leukotriene antagonists and systemic corticosteroids. In step V of Global Initiative for Asthma (GINA) management guidelines Anti Ig E, Omalizumab is recommended in selected patients when everything fails. But still some unmet need is felt in the form of refractory asthma. Mepolizumab, an IL-5 antagonist has been developed in this regard and has been approved by FDA on Nov 4, 2015 followed by European commission on Dec 02, 2015 in view of good results based on clinical trials conducted by GlaxoSmithKline a multi-centre, open-label long-term safety study of 100 milligram (mg) mepolizumab administered subcutaneously (SC) every 4 weeks for 12 months in addition to standard of care in subjects who have severe, refractory asthma and a history of eosinophilic inflammation. This article covers the review of mepolizumab with its advantages in refractory bronchial asthma

Predictors of mortality in patients of acute exacerbation of chronic obstructive pulmonary disease: A prospective observational study

Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) result in increased morbidity, mortality and tremendous socioeconomic burden. Predicting inhospital mortality may aid prognostication, planning for the site of care, i.e., ward versus intensive care units, and better individualization of treatment. Aim of Study: This study aims in predicting inhospital mortality in patients of AECOPD based on the parameters measured at the time of admission. Methods: Known COPD patients in acute exacerbations admitted in a tertiary care hospital were interrogated for clinical history and examination. All relevant laboratory tests including arterial blood gas analysis, complete blood count, liver and renal function tests, and random blood sugar were done. Based on outcome, patients were grouped into survivors and nonsurvivors. Parameters recorded were then subjected for univariate analysis to get their statistical significance. All significant variables on univariate analysis were then analyzed further with multivariate analysis. Results: Out of the total 140 patients included in the study, 24 (17%) died during their hospital stay. Of the various acute-phase parameters recorded at the time of the admission, only five qualified to be predictors of inhospital mortality based on univariate and multivariate analyses. These were partial pressure of carbon dioxide in arterial blood (PaCO2) (odds ratio [OR], 95% confidence interval [CI] =1.067, 0.993–1.146), pH (OR, 95% CI = 0.001, 0.001–0.584), serum glutamic pyruvate transaminase (SGPT) (OR, 95% CI = 1.032, 1.006–1.059), sodium (OR, 95% CI = 0.779, 0.689–0.881), and random blood sugar (OR, 95% CI = 1.018, 1.007–1.029). With these five factors combined, area under receiver operating characteristic (ROC) curve was 0.9684, sensitivity 79.18%, specificity 96.55%, positive predictive value 82.61%, negative predictive value 95.73%, and correctly classify acute exacerbation in 93.57%. Good survival can be expected if these parameters are within normal limits. Conclusion: pH, PaCO2, SGPT, serum sodium, and random blood sugar at the time of admission are independent predictors of mortality in patients of AECOPD. These can be helpful in developing a prediction tool of inhospital mortality in such patients

UTILITY OF BLIND PLEURAL BIOPSY IN UNDIAGNOSED PLEURAL EFFUSION USING ABRAMS NEEDLE

BACKGROUND As many as one-fifth of all the exudative pleural effusions remain non-diagnostic, despite all the routine biochemical and cytological examinations of pleural fluid. The aim of the study is to examine the role of closed pleural biopsy using Abrams needle in such cases of pleural effusion in a tertiary care hospital of central India. MATERIALS AND METHODS All the patients with initial non-diagnostic pleural fluid thoracentesis from January 2017 to October 2017 were included in the study and subjected to closed Abrams pleural biopsy. Biopsy sample was sent for histopathological examination, culture and CBNAAT (cartridge based nucleic acid amplification test) for tuberculosis. The patients who still remained nondiagnostic, further underwent other procedures as per the physician’s decision. Statistical analysis was then done on the data collected. RESULTS Closed percutaneous pleural biopsy was performed in 60 patients. It yielded granulomatous inflammation suggestive of tuberculosis in 17 (28.33%), out of them, 15 cases were also detected by the CBNAAT. All of them were rifampicin sensitive. Malignancy was detected in 12 (20%) patients, mixed inflammatory pattern with pus cells in 9 (15%) patients. Almost, 22 samples (36.66%) were declared nondiagnostic. CONCLUSION Our age old closed biopsy technique was diagnostic in almost 64% cases of non-diagnostic pleural fluid exudates on thoracentesis. This study supports the use of Abrams needle for investigation purpose of pleural fluid in economically constrained countries