Medication Use in Pregnant Women with Chronic Medical Conditions

Dr. Deborah Zeitlin addresses medication options for pregnant women with chronic conditions such as: hypertension, asthma, diabetes, and depression. Risks of medication use to the fetus are addressed

Do Antibiotics Improve Outcomes for Patients Hospitalized with COPD Exacerbations?

EVIDENCE-BASED ANSWER YES. Antibiotic use reduced mortality and treatment failure in patients hospitalized with acute exacerbations of chronic obstructive pulmonary disease (COPD) (strength of recommendation [SOR]: A, systematic reviews of randomized controlled trials [RCTs]). Giving antibiotics early to hospitalized patients decreased the need for later ventilation and readmission within 30 days for exacerbation of COPD (SOR: B, a retrospective cohort study)

Enhancing Compliance with Allergic Rhinitis Therapy

Allergic rhinitis is one of the most common chronic conditions in the US, surpassing even heart disease. Over $1 billion is spent annually for over-the-counter (OTC) and prescription medications. In addition, allergic rhinitis causes an estimated annual loss of$639 million related to lost work days and diminished work performance. If not effectively treated, allergic rhinitis may lead to potential complications such as otitis media, sinusitis, facial and dental abnormalities, hearing loss, poor speech development, and recurrent upper respiratory tract infections. Ineffective treatment often the result of intentional or unintentional noncompliance and inadequate patient education. Therefore, it is imperative that the clinician effectively educate the patient and tailor the treatment regimen so it enhances compliant behavior

Pharmacotherapy and Pregnancy: Highlights from the Third International Conference for Individualized Pharmacotherapy in Pregnancy

To address provider struggles to provide evidence-based, rational drug therapy to pregnant women, this third Conference was convened to highlight the current progress and research in the field. Speakers from academic centers, industry, and governmental institutions spoke about: the Food and Drug Administration’s role in pregnancy pharmacology and the new labeling initiative; drug registries in pregnancy; the pharmacist’s role in medication use in pregnancy; therapeutic areas such as preterm labor, gestational diabetes, nausea and vomiting in pregnancy, and hypertension; breast-feeding and medications; ethical challenges for consent in pregnancy drug studies; the potential for cord blood banks; and concerns about the fetus when studying drugs in pregnancy. The Conference highlighted several areas of collaboration within the current Obstetrics Pharmacology Research Units Network and hoped to educate providers, researchers, and agencies with the common goal to improve the ability to safely and effectively use individualized pharmacotherapy in pregnancy

Pulmonary Embolism as an Adverse Drug Event of Intravenous Immunoglobulin Therapy

TO THE EDITOR: Intravenous immunoglobulin (IVIG) therapy has gained popularity for the treatment of neuromuscular diseases (i.e., myasthenia gravis, inflammatory myopathy, chronic inflammatory demyelinating polyneuropathy), although adverse events are associated with high-dose IVIG infusions.1,2 Common adverse reactions to IVIG therapy are anxiety, headache, fever, chills, chest pain, dyspnea, nausea, and abdominal pain.3 More serious adverse events include anaphylaxis, hemolytic anemia, hepatitis C, and thrombosis.3 Studies have shown documented effects of IVIG on blood rheology. It increases plasma viscosity in a dose-related response and may also activate platelets.2–4 High-dose IVIG therapy is approximately 24–54 g/d.

Recommendations for data collection in cohort studies of preterm born individuals – the RECAP Preterm Core Dataset

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A common polymorphism in the Intelectin-1 gene influences mucus plugging in severe asthma

By incompletely understood mechanisms, type 2 (T2) inflammation present in the airways of severe asthmatics drives the formation of pathologic mucus which leads to airway mucus plugging. Here we investigate the molecular role and clinical significance of intelectin-1 (ITLN-1) in the development of pathologic airway mucus in asthma. Through analyses of human airway epithelial cells we find that ITLN1 gene expression is highly induced by interleukin-13 (IL-13) in a subset of metaplastic MUC5AC+ mucus secretory cells, and that ITLN-1 protein is a secreted component of IL-13-induced mucus. Additionally, we find ITLN-1 protein binds the C-terminus of the MUC5AC mucin and that its deletion in airway epithelial cells partially reverses IL-13-induced mucostasis. Through analysis of nasal airway epithelial brushings, we find that ITLN1 is highly expressed in T2-high asthmatics, when compared to T2-low children. Furthermore, we demonstrate that both ITLN-1 gene expression and protein levels are significantly reduced by a common genetic variant that is associated with protection from the formation of mucus plugs in T2-high asthma. This work identifies an important biomarker and targetable pathways for the treatment of mucus obstruction in asthma