Nasal lysine aspirin challenge in the diagnosis of aspirin - exacerbated respiratory disease

Background Aspirin-exacerbated respiratory disease is under-diagnosed and therefore effective and inexpensive therapy with aspirin desensitization is rarely performed. Methods We present an audit of 150 patients with difficult to treat nasal polyposis, 132 of whom also had asthma, 131 of whom underwent challenge with the only soluble form of aspirin, lysine aspirin (LAS), to confirm or exclude the diagnosis of aspirin-exacerbated respiratory disease (AERD). Results One hundred patients proved positive on nasal challenge, 31 who were negative went onto oral LAS challenge and a further 14 gave positive results, leaving 17 who were negative to a dose equivalent to over 375 mg of aspirin. Nineteen were not challenged because of contraindications. With the exception of one patient who developed facial angioedema and two patients with > 20% drop in FEV1 (following nasal plus oral challenge) no other severe adverse events occurred. No hospitalization was required for these three patients. Nasal inspiratory peak flow monitoring was less sensitive to obstruction caused by aspirin than was acoustic rhinometry – which should be employed when aspirin challenge is an outpatient procedure. Conclusions Provided patients are carefully chosen and monitored LAS challenge is suitable for ENT day case practice where respiratory physician help with asthma is available and should reduce the under-diagnosis of this condition

Playing the odds in clinical decision making: lessons from berry aneurysms undetected by magnetic resonance angiography

No description supplie

Peak nasal inspiratory flow and peak expiratory flow. Upright and sitting values in an adult population

Background: Nasal obstruction is correlated with a decreased quality of life . An easy way to evaluate nasal patency is the peak nasal inspiratory flow (PNIF) measurement. Normal PNIF values have been published by many authors. However, some authors evaluated volunteers in a sitting position, while others have measured PNIF values in standing volunteers. Body position has been shown to influence pulmonary function, with differences between sitting and upright positions. As nasal and pulmonary flows are strictly related, the present pilot study tried to establish whether PNIF/PEF changed with body position in adults. Methodology/Principal: PNIF and PEF were measured in sitting and standing positions with the order of testing randomized in 76 healthy volunteers, 30 male (40 ±16 years). Results: In the group as a whole between sitting and upright position, PEF was significantly different (p=0.009), while PNIF showed a trend towards a significant difference (p=0.10). Conclusions: The present study, although showing a generally positive effect of the standing position on PEF values, does not show a clear effect on PNIF

Role of Echocardiography in Percutaneous Mitral Valve Interventions

Intraprocedural imaging continues to evolve in parallel with advances in percutaneous mitral valve interventions. This didactic review uses several illustrations and rich intraprocedural videos to further describe and demonstrate the role of the most up-to-date echocardiographic and advanced imaging technologies in the patient selection and intraprocedural guidance of percutaneous mitral valve interventions. We will focus on 3 interventions: 1) percutaneous balloon mitral valvuloplasty for mitral stenosis; 2) transcatheter edge-to-edge repair of mitral valve regurgitation; and 3) transcatheter closure of periprosthetic mitral regurgitation. In addition, we discuss potential pitfalls of 3-dimensional transesophageal echocardiography and show examples of this technique

Pre-asthma : a useful concept? A EUFOREA paper. Part 2—late onset eosinophilic asthma

Peer reviewe

The hidden burden of adult allergic rhinitis : UK healthcare resource utilisation survey

Funding Funding for this survey was provided by Meda Pharma.Peer reviewedPublisher PD

Pre-asthma : a useful concept for prevention and disease-modification? A EUFOREA paper. Part 1—allergic asthma

Funding The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.Peer reviewedPublisher PD

Effect of Specific Immunoglobulin E Response and Comorbidities on Effectiveness of MP-AzeFlu in a Real-Life Study

Acknowledgements: We would like to thank the subjects who participated in the trial. Funding Sources: This study was supported by MEDA Pharma GmbH & Co. KG (a Mylan Company), Bad Homburg, Germany. Technical, editorial, and medical writing assistance were provided under the direction of the authors by Strategix, an affiliate of The Lynx Group, LLC. This assistance was supported by MEDA Pharma GmbH & Co. KG (a Mylan Company).Peer reviewedPublisher PD