600 research outputs found

    LINX®, a novel treatment for patients with refractory asthma complicated by gastroesophageal reflux disease: a case report.

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    BackgroundGastroesophageal reflux disease is one of the most common comorbidities in patients with asthma. Gastroesophageal reflux disease can be linked to difficult-to-control asthma. Current management includes gastric acid suppression therapy and surgical antireflux procedures. The LINX® procedure is a novel surgical treatment for patients with gastroesophageal reflux disease refractory to medical therapy. To the best of our knowledge, we report the first case of successful treatment of refractory asthma secondary to gastroesophageal reflux disease using the LINX® procedure.Case presentationOur patient was a 22-year-old white woman who met the American Thoracic Society criteria for refractory asthma that had remained poorly controlled for 5 years despite progressive escalation to step 6 treatment as recommended by National Institutes of Health-National Asthma Education and Prevention Program guidelines, including high-dose oral corticosteroids, high-dose inhaled corticosteroid plus long-acting β2-agonist, leukotriene receptor antagonist, and monthly omalizumab. Separate trials with azithromycin therapy and roflumilast did not improve her asthma control, nor did bronchial thermoplasty help. Additional consultations with two other university health systems left the patient with few treatment options for asthma, which included cyclophosphamide. Instead, the patient underwent a LINX® procedure after failure of maximal medical therapy for gastroesophageal reflux disease with the additional aim of improving asthma control. After she underwent LINX® treatment, her asthma improved dramatically and was no longer refractory. She had normal exhaled nitric oxide levels and loss of peripheral eosinophilia after LINX® treatment. Prednisone was discontinued without loss of asthma control. The only immediate adverse effects due to the LINX® procedure were bloating, nausea, and vomiting.ConclusionsLINX® is a viable alternative to the Nissen fundoplication procedure for the treatment of patients with gastroesophageal reflux disease and poorly controlled concomitant refractory asthma

    The Asthma-COPD Overlap Syndrome: A Common Clinical Problem in the Elderly

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    Many patients with breathlessness and chronic obstructive lung disease are diagnosed with either asthma, COPD, or—frequently—mixed disease. More commonly, patients with uncharacterized breathlessness are treated with therapies that target asthma and COPD rather than one of these diseases. This common practice represents the difficulty in distinguishing these disorders clinically, particularly in patients with a history that does not easily differentiate asthma from COPD. A common clinical scenario is an older former smoker with partially reversible or fixed airflow obstruction and evidence of atopy, demonstrating “overlap” features of asthma and COPD. We stress that asthma-COPD overlap syndrome becomes more prevalent with advancing age as patients respond less favorably to guideline-recommended drug therapy. We review the similarities and differences in clinical characteristics between these disorders, and their physiologic and inflammatory profiles within the context of the aging patient. We underscore the difficulties in differentiating asthma from COPD in current or former smokers, share our institutional experience with overlap syndrome, and highlight the need for new research to better characterize and investigate this important clinical phenotype

    A Review of Adult Mortality Due to 2009 Pandemic (H1N1) Influenza A in California

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    BACKGROUND: While children and young adults had the highest attack rates due to 2009 pandemic (H1N1) influenza A (2009 H1N1), studies of hospitalized cases noted high fatality in older adults. We analyzed California public health surveillance data to better characterize the populations at risk for dying due to 2009 H1N1. METHODS AND FINDINGS: A case was an adult ≥20 years who died with influenza-like symptoms and laboratory results indicative of 2009 H1N1. Demographic and clinical data were abstracted from medical records using a standardized case report form. From April 3, 2009-August 10, 2010, 541 fatal cases ≥20 years with 2009 H1N1 were reported. Influenza fatality rates per 100,000 population were highest in persons 50-59 years (3.5; annualized rate = 2.6) and 60-69 years (2.3; annualized rate = 1.7) compared to younger and older age groups (0.4-1.9; annualized rates = 0.3-1.4). Of 486 cases hospitalized prior to death, 441 (91%) required intensive care unit (ICU) admission. ICU admission rates per 100,000 population were highest in adults 50-59 years (8.6). ICU case-fatality ratios among adults ranged from 24-42%, with the highest ratios in persons 70-79 years. A total of 425 (80%) cases had co-morbid conditions associated with severe seasonal influenza. The prevalence of most co-morbid conditions increased with increasing age, but obesity, pregnancy and obstructive sleep apnea decreased with age. Rapid testing was positive in 97 (35%) of 276 tested. Of 482 cases with available data, 384 (80%) received antiviral treatment, including 49 (15%) of 328 within 48 hours of symptom onset. CONCLUSIONS: Adults aged 50-59 years had the highest fatality due to 2009 H1N1; older adults may have been spared due to pre-existing immunity. However, once infected and hospitalized in intensive care, case-fatality ratios were high for all adults, especially in those over 60 years. Vaccination of adults older than 50 years should be encouraged

    Rozpoznawanie i leczenie zaostrzeń przewlekłej obturacyjnej choroby płuc i przewlekłego zapalenia oskrzeli u chorych w podeszłym wieku

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    Na zespół przewlekłej obturacyjnej choroby płuc (POChP) składają się przewlekłe zapalenie oskrzeli (PZO), rozstrzenie oskrzeli, rozedma i odwracalne zmiany w drogach oddechowych, które tworzą swoiste połączenia u poszczególnych chorych. Chorzy w podeszłym wieku są narażeni na ryzyko zachorowania na POChP i jej składowe — rozedmę, PZO i rozstrzenie oskrzeli. Zakażenia bakteryjne i wirusowe odgrywają rolę w zaostrzeniach POChP i w zaostrzeniach PZO bez cech POChP. Chorzy w podeszłym wieku podczas epizodów zaostrzeń POChP i PZO są narażeni na ryzyko działania opornych bakterii, do których należą często stwierdzane w zaostrzeniach POChP i PZO między innymi Haemophilus influenzae, Moraxella catarrhalis i Streptococcus pneumoniae. Rzadziej spotykane niejelitowe bakterie Gram-ujemne, w tym Pseudomonas aeruginosa, bakterie Gram-dodatnie, w tym Staphylococcus aureus, i szczepy niegruźliczych mykobakterii są częściej stwierdzane w zaostrzeniach POChP/PZO u chorych w podeszłym wieku z częstymi epizodami PZO lub u pacjentów z rozstrzeniami oskrzeli. Wytyczne dotyczące leczenia antybiotykami w zależności od stopnia ryzyka wydają się użyteczne w przypadku ropnych zaostrzeń POChP i w zaostrzeniach PZO. Wytyczne te nie zostały prospektywnie potwierdzone dla ogólnej populacji ani w odniesieniu do grupy osób w podeszłym wieku. Posługując się stratyfikacją ryzyka dla chorych w podeszłym wieku, antybiotyki pierwszego rzutu (np. amoksycylina, ampicylina, piwampicylina, trimetoprim/sulfametoksazol i doksycyklina) z bardziej ograniczonym spektrum antybakteryjnym stosuje się u chorych, u których prawdopodobieństwo stwierdzenia w czasie zaostrzeń POChP/PZO opornych bakterii jest mniejsze. Antybiotyki drugiego rzutu (np. amoksycylina/ /kwas klawulanowy, cefalosporyny II lub III generacji i fluorochinolony stosowane w zakażeniach układu oddechowego) o szerszym spektrum działania są zarezerwowane dla chorych z istotnymi czynnikami ryzyka zakażenia opornymi drobnoustrojami i tych pacjentów, u których początkowe leczenie antybiotykami się nie powiodło. Medycyna Wieku Podeszłego 2011, 1 (1), 1–1

    Interaction of nitrogen dioxide with human plasma Antioxidant depletion and oxidative damage

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    AbstractNitrogen dioxide (NO*2) is often present in inhaled air and may be generated in vivo from nitric oxide. Exposure of human blood plasma to NO*2 caused rapid losses of ascorbic acid, uric acid and protein thiol groups, as well as lipid peroxidation and depletions of α-tocopherol, bilirubin and ubiquinol-10. No increase in protein carbonyls was detected. Supplementation of plasma with ascorbate decreased the rates of lipid peroxidation. α-tocopherol depletion and loss of uric acid. Uric acid supplementation decreased rates of lipid peroxidation but not the loss of α-tecopherol. We conclude that ascorbic acid, protein -SH groups, uric acid and α-tocopherol may be important agents protecting against NO*2 in vivo. If these antioxidants are depleted, peroxidation of lipids occurs and might contribute to the toxicity of NO*2

    Use of Intravenous Peramivir for Treatment of Severe Influenza A(H1N1)pdm09

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    Oral antiviral agents to treat influenza are challenging to administer in the intensive care unit (ICU). We describe 57 critically ill patients treated with the investigational intravenous neuraminidase inhibitor drug peramivir for influenza A (H1N1)pdm09 [pH1N1]. Most received late peramivir treatment following clinical deterioration in the ICU on enterically-administered oseltamivir therapy. The median age was 40 years (range 5 months-81 years). Common clinical complications included pneumonia or acute respiratory distress syndrome requiring mechanical ventilation (54; 95%), sepsis requiring vasopressor support (34/53; 64%), acute renal failure requiring hemodialysis (19/53; 36%) and secondary bacterial infection (14; 25%). Over half (29; 51%) died. When comparing the 57 peramivir-treated cases with 1627 critically ill cases who did not receive peramivir, peramivir recipients were more likely to be diagnosed with pneumonia/acute respiratory distress syndrome (p = 0.0002) or sepsis (p = <0.0001), require mechanical ventilation (p = <0.0001) or die (p = <0.0001). The high mortality could be due to the pre-existing clinical severity of cases prior to request for peramivir, but also raises questions about peramivir safety and effectiveness in hospitalized and critically ill patients. The use of peramivir merits further study in randomized controlled trials, or by use of methods such as propensity scoring and matching, to assess clinical effectiveness and safety