Asthma and coagulation: A clinical and pathophysiological evaluation

In clinical practice pulmonologists have suspected that pulmonary embolisms occur more often in patients with asthma. To confirm this suspicion, a study was initiated to investigate the incidence of venous thromboembolic events in patients with asthma compared to the general population. In addition, this study aimed to determine if any relationship between asthma and venous thromboembolic events could be attributed to asthma severity, viral infections or the use of asthma medication. The activation of coagulation in asthma was further explored in patients and healthy subjects in an attempt to understand the relationship between asthma and pulmonary embolisms. Results from these studies show that pulmonary embolisms do indeed occur more frequently in patients with asthma as a consequence of an enhanced procoagulant state. Moreover, this procoagulant state is augmented by severe forms of asthma, viral infections (often the cause of an asthma exacerbation) and by the use of oral corticosteroids (central to the treatment of asthma exacerbations and patients with severe asthma). These findings are important, as they should make pulmonologists and general physicians aware of the procoagulant changes that occur in patients with asthma. These results can also be extrapolated to patients with other inflammatory diseases requiring corticosteroid treatment making the results relevant to all physicians treating patients with oral corticosteroids

[Diffuse panbronchiolitis in an Asian woman with severely obstructed pulmonary disease],[Diffuse panbronchiolitis in an Asian woman with severely obstructed pulmonary disease]

Contains fulltext : 49496.pdf (publisher's version ) (Closed access)A 41-year-old woman was referred for severely obstructed pulmonary disease 4 years after she stopped smoking. Treatment for chronic obstructive pulmonary disease (COPD) had no effect and lung function worsened in the following years. The clinical, radiological and pathological characteristics led us to the diagnosis of diffuse panbronchiolitis. She was treated with clarithromycin. After 1 year, major improvement was seen in clinical, radiological and spirometric features. Diffuse panbronchiolitis is a rare obstructive disorder that is usually seen in people of Japanese descent. Patients respond well to treatment with low-dose macrolide treatment

[Diffuse panbronchiolitis in an Asian woman with severely obstructed pulmonary disease]

A 41-year-old woman was referred for severely obstructed pulmonary disease 4 years after she stopped smoking. Treatment for chronic obstructive pulmonary disease (COPD) had no effect and lung function worsened in the following years. The clinical, radiological and pathological characteristics led us to the diagnosis of diffuse panbronchiolitis. She was treated with clarithromycin. After 1 year, major improvement was seen in clinical, radiological and spirometric features. Diffuse panbronchiolitis is a rare obstructive disorder that is usually seen in people of Japanese descent. Patients respond well to treatment with low-dose macrolide treatment

Toxische epidermale necrolyse bij een hiv-geinfecteerde patient.

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A rare cause of chylothorax and lymph edema.

Chylothorax is a form of pleural effusion rarely caused by metastasis of solid tumors. Because chylothorax causes complaints by local compression of the lung, as well as weight loss resulting from loss of triglycerides, it needs thorough investigation. We present the case of gastric carcinoma presenting with a chylothorax and unilateral lymph edema. Although rare, the differential diagnosis of chylothorax should include gastric cancer even in the absence of upper abdominal complaints

Use of Oral Glucocorticoids and the Risk of Pulmonary Embolism A Population-Based Case-Control Study

Recently, endogenous glucocorticoid excess has been identified as a risk factor for VTE. Whether exogenous use of glucocorticoids is associated with an increased risk of VTE is unclear. We aimed to quantify the risk of symptomatic pulmonary embolism (PE) in patients using corticosteroids. A case-control study using the PHARMO Record Linkage System, a Dutch population-based pharmacy registry, was conducted. Cases were 4,495 patients with a first hospital admission for PE between 1998 and 2008. Control subjects were 16,802 sex- and age-matched subjects without a history of PE. International Classification of Diseases codes for hospitalization were used to retrieve information on underlying conditions. The risk of PE was highest in the first 30 days of glucocorticoid exposure (adjusted OR, 5.9; 95% CI, 2.3-3.9) and gradually decreased with increasing duration of use (OR, 1.9; 95% CI, 1.3-2.9) for long-term users (> 1 year). Low-dose glucocorticoid use (prednisolone daily dose equivalent 30 mg) (OR, 9.6; 95% CI, 4.3-20.5). Stratification for both duration and dose of glucocorticoid showed the highest risk of PE in recently started users compared with long-term users at the time of PE, irrespective of the dose. Patients treated with oral glucocorticoids may be at an increased risk of PE, especially during the first month of exposure. This hypothesis requires confirmation in future studie