Respiratory System Diseases & Disorders
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Allergic Bronchopulmonary Aspergillosis Revealing Asthma
CASE REPORT published: 22 June 2021 doi: 10.3389/fimmu.2021.695954 Case Report: Allergic Bronchopulmonary Aspergillosis Revealing Asthma Houda Snen 1,2*, Aicha Kallel 2,3*, Hana Blibech 1,2, Sana Jemel 2,3, Nozha Ben Salah 1,2, Sonia Marouen 3, Nadia Mehiri 1,2, Slah Belhaj 3, Bechir Louzir 1,2 and Kalthoum Kallel 2,3 1 Pulmonary Department, Hospital Mongi Slim, La Marsa, Tunisia, 2 Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia, 3 Parasitology and Mycology Department, La Rabta Hospital, Tunis, Tunisia Allergic bronchopulmonary aspergillosis (ABPA) is an immunological pulmonary disorder caused by hypersensitivity to Aspergillus which colonizes the airways of patients with asthma and cystic fibrosis. Its diagnosis could be difficult in some cases due to atypical Edited by: presentations especially when there is no medical history of asthma. Treatment of ABPA is Brian Stephen Eley, frequently associated to side effects but cumulated drug toxicity due to different molecules University of Cape Town, South Africa is rarely reported. An accurate choice among the different available molecules and Reviewed by: effective on ABPA is crucial. We report a case of ABPA in a woman without a known Shivank Singh, Southern Medical University, China history of asthma. She presented an acute bronchitis with wheezing dyspnea leading to an Richard B. Moss, acute respiratory failure. She was hospitalized in the intensive care unit. The Stanford University, United States bronchoscopy revealed a complete obstruction of the left primary bronchus by a sticky *Correspondence: Houda Snen greenish material. The culture of this material isolated Aspergillus fumigatus and that of [email protected] bronchial aspiration fluid isolated Pseudomonas aeruginosa. -
Symptoms Related to Asthma and Chronic Bronchitis in Three Areas of Sweden
Eur Respir J, 1994, 7, 2146–2153 Copyright ERS Journals Ltd 1994 DOI: 10.1183/09031936.94.07122146 European Respiratory Journal Printed in UK - all rights reserved ISSN 0903 - 1936 Symptoms related to asthma and chronic bronchitis in three areas of Sweden E. Björnsson*, P. Plaschke**, E. Norrman+, C. Janson*, B. Lundbäck+, A. Rosenhall+, N. Lindholm**, L. Rosenhall+, E. Berglund++, G. Boman* Symptoms related to asthma and chronic bronchitis in three areas of Sweden. E. Björnsson, *Dept of Lung Medicine and Asthma P. Plaschke, E. Norrman, C. Janson, B. Lundbäck, A. Rosenhall, N. Lindholm, L. Research Center, Akademiska sjukhu- Rosenhall, E. Berglund, G. Boman. ERS Journals Ltd 1994. set, Uppsala University, Uppsala, Sweden. ABSTRACT: Does the prevalence of respiratory symptoms differ between regions? **Asthma and Allergy Research Center, Sahlgren's Hospital, University of Göteborg, As a part of the European Community Respiratory Health Survey, we present data Göteborg, Sweden. +Dept of Pulmonary from an international questionnaire on asthma symptoms occurring during a 12 Medicine and Allergology, Univer- month period, smoking and symptoms of chronic bronchitis. The questionnaire was sity Hospital of Northern Sweden, Umeå, mailed to 10,800 persons aged 20–44 yrs living in three regions of Sweden (Västerbotten, Sweden. ++Dept of Pulmonary Medicine, Uppsala and Göteborg) with different environmental characteristics. The total Sahlgrenska University Hospital, Göteborg, response rate was 86%. Sweden. Wheezing was reported by 20.5%, and the combination of wheezing without a Correspondence: E. Björnsson, Dept of cold and wheezing with breathlessness by 7.4%. The use of asthma medication was Lung Medicine, Akademiska sjukhuset, S- reported by 5.3%. -
Chest Pain and Non-Respiratory Symptoms in Acute Asthma
Postgrad Med J 2000;76:413–414 413 Chest pain and non-respiratory symptoms in Postgrad Med J: first published as 10.1136/pmj.76.897.413 on 1 July 2000. Downloaded from acute asthma W M Edmondstone Abstract textbooks. Occasionally the combination of The frequency and characteristics of chest dyspnoea and chest pain results in diagnostic pain and non-respiratory symptoms were confusion. This study was prompted by the investigated in patients admitted with observation that a number of patients admitted acute asthma. One hundred patients with with asthmatic chest pain had been suspected a mean admission peak flow rate of 38% of having cardiac ischaemia, pleurisy, pericardi- normal or predicted were interviewed tis, or pulmonary embolism. It had also been using a questionnaire. Chest pain oc- observed that many patients admitted with curred in 76% and was characteristically a asthma complained of a range of non- dull ache or sharp, stabbing pain in the respiratory symptoms, something which has sternal/parasternal or subcostal areas, been noted previously in children1 and in adult worsened by coughing, deep inspiration, asthmatics in outpatients.2 The aim of this or movement and improved by sitting study was to examine the frequency and char- upright. It was rated at or greater than acteristics of chest pain and other symptoms in 5/10 in severity by 67% of the patients. A patients admitted with acute asthma. wide variety of upper respiratory and sys- temic symptoms were described both Patients and methods before and during the attack. One hundred patients (66 females, mean (SD) Non-respiratory symptoms occur com- age 45.0 (19.7) years) admitted with acute monly in the prodrome before asthma asthma were studied. -
Acute (Serious) Bronchitis
Acute (serious) Bronchitis This is an infection of the air tubes that go down to your lungs. It often follows a cold or the flu. Most people do not need treatment for this. The infection normally goes away in 7-10 days. We make every effort to make sure the information is correct (right). However, we cannot be responsible for any actions as a result of using this information. Getting Acute Bronchitis How the lungs work Your lungs are like two large sponges filled with tubes. As you breathe in, you suck oxygen through your nose and mouth into a tube in your neck. Bacteria and viruses in the air can travel into your lungs. Normally, this does not cause a problem as your body kills the bacteria, or viruses. However, sometimes infection can get through. If you smoke or if you have had another illness, infections are more likely to get through. Acute Bronchitis Acute bronchitis is when the large airways (breathing tubes) to the lungs get inflamed (swollen and sore). The infection makes the airways swell and you get a build up of phlegm (thick mucus). Coughing is a way of getting the phlegm out of your airways. The cough can sometimes last for up to 3 weeks. Acute Bronchitis usually goes away on its own and does not need treatment. We make every effort to make sure the information is correct (right). However, we cannot be responsible for any actions as a result of using this information. Symptoms (feelings that show you may have the illness) Symptoms of Acute Bronchitis include: • A chesty cough • Coughing up mucus, which is usually yellow, or green • Breathlessness when doing more energetic activities • Wheeziness • Dry mouth • High temperature • Headache • Loss of appetite The cough usually lasts between 7-10 days. -
Allergic Bronchopulmonary Aspergillosis and Severe Asthma with Fungal Sensitisation
Allergic Bronchopulmonary Aspergillosis and Severe Asthma with Fungal Sensitisation Dr Rohit Bazaz National Aspergillosis Centre, UK Manchester University NHS Foundation Trust/University of Manchester ~ ABPA -a41'1 Severe asthma wl'th funga I Siens itisat i on Subacute IA Chronic pulmonary aspergillosjs Simp 1Ie a:spe rgmoma As r§i · bronchitis I ram une dysfu net Ion Lun· damage Immu11e hypce ractivitv Figure 1 In t@rarctfo n of Aspergillus Vliith host. ABP A, aHerg tc broncho pu~ mo na my as µe rgi ~fos lis; IA, i nvas we as ?@rgiH os 5. MANCHl·.'>I ER J:-\2 I Kosmidis, Denning . Thorax 2015;70:270–277. doi:10.1136/thoraxjnl-2014-206291 Allergic Fungal Airway Disease Phenotypes I[ Asthma AAFS SAFS ABPA-S AAFS-asthma associated with fu ngaIsensitization SAFS-severe asthma with funga l sensitization ABPA-S-seropositive a llergic bronchopulmonary aspergi ll osis AB PA-CB-all ergic bronchopulmonary aspergi ll osis with central bronchiectasis Agarwal R, CurrAlfergy Asthma Rep 2011;11:403 Woolnough K et a l, Curr Opin Pulm Med 2015;21:39 9 Stanford Lucile Packard ~ Children's. Health Children's. Hospital CJ Scanford l MEDICINE Stanford MANCHl·.'>I ER J:-\2 I Aspergi 11 us Sensitisation • Skin testing/specific lgE • Surface hydroph,obins - RodA • 30% of patients with asthma • 13% p.atients with COPD • 65% patients with CF MANCHl·.'>I ER J:-\2 I Alternar1a• ABPA •· .ABPA is an exagg·erated response ofthe imm1une system1 to AspergUlus • Com1pUcatio n of asthm1a and cystic f ibrosis (rarell·y TH2 driven COPD o r no identif ied p1 rior resp1 iratory d isease) • ABPA as a comp1 Ucation of asth ma affects around 2.5% of adullts. -
Obliterative Bronchiolitis, Cryptogenic Organising Pneumonitis and Bronchiolitis Obliterans Organizing Pneumonia: Three Names for Two Different Conditions
Eur Reaplr J EDITORIAL 1991, 4, 774-775 Obliterative bronchiolitis, cryptogenic organising pneumonitis and bronchiolitis obliterans organizing pneumonia: three names for two different conditions R.M. du Bois, O.M. Geddes Over the last five years, increasing confusion has has been applied to conditions in which airflow obstruc developed over the use of the terms "bronchiolitis tion is prominent and in which response to treatment is obliterans" and "bronchiolitis obliterans organizing poor. pneumonia". The confusion stems largely from the common use of the term "bronchiolitis obliterans" or "obliterative bronchiolitis" in the diagnostic labels applied "Cryptogenic organizing pneumonitis" or "bronchi· to two entities which are quite distinct clinically but which otitis obliterans organizing pneumonia" (BOOP) bear certain resemblances histologically. Cryptogenic organizing pneumonitis was first described by DAVISON et al. [7] in 1983. The clinical syndrome ObUterative bronchiolitis consisted of breathlessness, malaise, fever, high erythrocyte sedimentation rate (ESR), pneumonic In 1977, GEODES et al. [1] reported the case histories shadowing on chest radiograph with a restrictive of six patients whose clinical condition was characterized pulmonary function defect and low gas transfer coeffi by airways obliteration in association with rheumatoid cient. On histological examination of lung biopsy mate· arthritis. The striking clinical features were of rapidly rial, the typical and distinguishing feature was the progressive breathlessness and the fmding on examination presence of connective tissue within the alveoli, alveolar of a high-pitched mid-inspiratory squeak heard over the ducts and, occasionally, in respiratory bronchioles. This lung fields. Chest radiographs showed hyperinflated lungs connective tissue consisted of "loosely woven fibres of but were otherwise normal. -
Management of Wheeze and Cough in Infants and Pre-Schoo L Children In
nPersonal opinio lManagement of wheeze and cough in infants and pre-schoo echildren in primary car Pauln Stephenso nIntroductio is, well established in adults 2thoughs there remain somer controversy about its diagnosis in children eve Managementa of wheeze and cough in children is sinceh Spelman's uncontrolled study of children wit commonm problem in primary care. In this paper I ai nchronic cough successfully treated according to a tod provide a few useful management tools with regar .asthma protocol 3gWithout the ability to perform lun toe diagnosis, the role of a trial of treatment, and th functione tests in pre-school children, care must b rationalee for referral. For an in-depth review see th takent to exclude other diagnoses. A persisten article. in this journal two years ago by Bush 1 eproductiv coughc may be due solely to chroni catarrhe with postnasal drip, but early referral may b sPresentation of Symptom needed. A persistent dry cough,n worse at night and o exercise,s and without evidence of other diagnose Ity is always worth asking parents what they mean b warrants. a trial of asthma treatment thed term 'wheeze' or 'cough'. The high-pitche musicaln noise of a wheeze usually on expiratio Thef younger the child, the longer the list o shouldy not be confused with the sound of inspirator differentialo diagnoses and the more one has t sstridor. The sound of airflow through secretions i econsider possibilities other than 'asthma'. Thes ddifferent again, and parents may describe their chil linclude upper airways disease, congenital structura 'vomiting'g when, in fact, the child has been coughin diseasel of the bronchi, bronchial or trachea severely and bringing up phlegm or mucus. -
Gas Exchange and Respiratory Function
LWBK330-4183G-c21_p484-516.qxd 23/07/2009 02:09 PM Page 484 Aptara Gas Exchange and 5 Respiratory Function Applying Concepts From NANDA, NIC, • Case Study and NOC A Patient With Impaired Cough Reflex Mrs. Lewis, age 77 years, is admitted to the hospital for left lower lobe pneumonia. Her vital signs are: Temp 100.6°F; HR 90 and regular; B/P: 142/74; Resp. 28. She has a weak cough, diminished breath sounds over the lower left lung field, and coarse rhonchi over the midtracheal area. She can expectorate some sputum, which is thick and grayish green. She has a history of stroke. Secondary to the stroke she has impaired gag and cough reflexes and mild weakness of her left side. She is allowed food and fluids because she can swallow safely if she uses the chin-tuck maneuver. Visit thePoint to view a concept map that illustrates the relationships that exist between the nursing diagnoses, interventions, and outcomes for the patient’s clinical problems. LWBK330-4183G-c21_p484-516.qxd 23/07/2009 02:09 PM Page 485 Aptara Nursing Classifications and Languages NANDA NIC NOC NURSING DIAGNOSES NURSING INTERVENTIONS NURSING OUTCOMES INEFFECTIVE AIRWAY CLEARANCE— RESPIRATORY MONITORING— Return to functional baseline sta- Inability to clear secretions or ob- Collection and analysis of patient tus, stabilization of, or structions from the respiratory data to ensure airway patency improvement in: tract to maintain a clear airway and adequate gas exchange RESPIRATORY STATUS: AIRWAY PATENCY—Extent to which the tracheobronchial passages remain open IMPAIRED GAS -
SAR156597 in Idiopathic Pulmonary Fibrosis: a Phase 2, Placebo-Controlled Study (DRI11772)
ERJ Express. Published on October 18, 2018 as doi: 10.1183/13993003.01130-2018 Early View Original article SAR156597 in idiopathic pulmonary fibrosis: a phase 2, placebo-controlled study (DRI11772) Ganesh Raghu, Luca Richeldi, Bruno Crestani, Peter Wung, Raphael Bejuit, Corinne Esperet, Christian Antoni, Christina Soubrane Please cite this article as: Raghu G, Richeldi L, Crestani B, et al. SAR156597 in idiopathic pulmonary fibrosis: a phase 2, placebo-controlled study (DRI11772). Eur Respir J 2018; in press (https://doi.org/10.1183/13993003.01130-2018). This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Copyright ©ERS 2018 Copyright 2018 by the European Respiratory Society. SAR156597 in idiopathic pulmonary fibrosis: a phase 2, placebo-controlled study (DRI11772) Ganesh Raghu1, Luca Richeldi2, Bruno Crestani3, Peter Wung4, Raphael Bejuit5, Corinne Esperet5, Christian Antoni5 and Christina Soubrane5 Affiliations: 1Center for Interstitial Lung Diseases, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington Medical Center, Seattle, WA, USA. 2Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolicà del Sacro Cuore, Roma, Italy. 3APHP, Hôpital Bichat, Service de Pneumologie A, Centre de Référence Constitutif des Maladies Pulmonaires Rares, DHU FIRE, Paris, France; Université Paris Diderot, Sorbonne Paris Cité; INSERM Unité 1152, Paris, France. 4Medical Operations, Sanofi R&D, Bridgewater, NJ, USA. 5Immunology and Inflammation Therapeutic Area, Sanofi R&D, Paris, France. -
Chief Compaint/HPI History
PULMONOLOGY ASSOCIATES OF TEXAS 6860 North Dallas Pkwy, Ste 200, Plano, TX 75024 Tel: 469-305-7171 Fax: 469-212-1548 Patient Name: Thomas Cromwell Patient DOB: 02-09-1960 Patient Sex: Male Visit Date: 03-06-2016 Chief Compaint/HPI Chief Complaint: Shortness of Breath History of Present Illness: he patient is an 56-year-old male. From the last few days, he is not feeling well. Complains of fatigue, tiredness, weakness, nausea, no vomiting, no hematemesis or melena. The patient relates to have some low-grade fever. The patient came to the emergency room. Initially showed atrial fibrillation with rapid ventricular response. It appears that the patient has chronic atrial fibrillation. As per the medications, they are not very clear. He denies any specific chest pain. Her main complaint is shortness of breath and symptoms as above Pulmonary symptoms: cough, sputum, no hemoptysis, dyspnea and wheezing. History Past Medical History: Pulmonary history includes pneumonia and sleep apnea. Cardiac history includes atrial fibrillation and congestive heart failure. Remainder of PMH is non-significant. Surgical History: appendectomy in 2007. Medications: Pulmonary medications are albuterol and Spiriva; Cardiac medications include: atenolol and digoxin; Family History: Father is deceased at age 80. Father PMH remarkable for CHF, hypertension and MI; Mother is alive. Mother PMH remarkable for alzheimers, diabetes and hypertension; Cancer history in family: No Lung disease in the family: No Social History: Current every day smoker - 1 pack / day Alcohol consumption: social Marital status: lives alone Exposure History: Occupation: farmer. Asbestos exposure: None. No exposure to Ground Zero. Immunization History: Patient has an immunization history of flu shot, H1N1shot and pneumococcal shot. -
Antibiotic Prescribing for Acute Bronchitis: How Low Can We Go?
J Am Board Fam Pract: first published as 10.3122/15572625-13-6-462 on 1 November 2000. Downloaded from Antibiotic Prescribing for Acute Bronchitis: How Low Can We Go? By the time I graduated from medical school in of that wise philosopher Pogo, "We have seen the 1975, I had learned that most respiratory tract enemy, and he is us." infections in otherwise healthy children and adults No doubt, we can do better. Several investiga were caused by viruses, such as parainfiuenza, in tors have described successful methods of reducing fluenza, adenovirus, and respiratory syncytial virus. antibiotic use for respiratory tract infections. This learning was reinforced during my family Gonzales et al2 found that combined patient and practice residency training in Charleston, Se. I was clinician education was effective in reducing anti taught that the challenge of primary care practice is biotic use for acute bronchitis from 74% to 48% in to distinguish the many patients with benign, self a health maintenance organization setting. Using a limited respiratory tract infections from those pa quality improvement approach and a computer tients who are more seriously ill with bacterial based patient record in an academic family practice pneumonia and who need an antibiotic to recover setting, Ornstein and colleagues3 reduced antibi more quickly and more certainly. Anned with this otic prescribing for acute bronchitis from 60% to scientific knowledge, I marched valiantly into prac less than 30%. tice, determined to base my prescribing on good These and other initiatives show that it is pos science. It was only in rural practice that I clearly sible to reduce use of antibiotics for acute respira recall regularly confronting syndromes called tory tract infections, but how low can we go? The 4 "acute bronchitis" and "sinusitis," for which pa report by Hueston et al in this issue of the JABFP suggests that, for patients with the diagnosis of tients seemed to expect an antibiotic and for which acute bronchitis, the answer might not be 0%. -
Approach to Type 2 Respiratory Failure Changing Nature of NIV
Approach to type 2 Respiratory Failure Changing Nature of NIV • Not longer just the traditional COPD patients • Increasingly – Obesity – Neuromuscular – Pneumonias • 3 fold increase in patients with Ph 7.25 and below Impact • Changing guidelines • Increased complexity • Increased number of patients • Decreased threshold for initiation • Lower capacity for ITU to help • Higher demands on nursing staff Resp Failure • Type 1 Failure of Oxygenation • Type 2 Failure of Ventilation • Hypoventilation • Po2 <8 • Pco2 >6 • PH low or bicarbonate high Ventilation • Adequate Ventilation – Breathe in deeply enough to hit a certain volume – Breathe out leaving a reasonable residual volume – Breath quick enough – Tidal volume and minute ventilation Response to demand • Increase depth of respiration • Use Reserve volume • Increase rate of breathing • General increase in minute ventilation • More gas exchange Failure to match demand • Hypoventilation • Multifactorial • Can't breathe to a high enough volume • Can't breath quick enough • Pco2 rises • Po2 falls Those at risk • COPD • Thoracic restriction • Central • Neuromuscular • Acute aspects – Over oxygenation – Pulmonary oedema Exhaustion • Complicates all forms of resp failure • Type one will become type two • Needs urgent action • Excessive demand • Unable to keep up • Resp muscle hypoxia Exhaustion • Muscles weaken • Depth of inspiration drops • Residual volume drops • Work to breath becomes harder • Spiral of exhaustion • Pco2 rises, Po2 drops Type 2 Respiratory Failure Management Identifying Those