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Home , Croup

36 Pulmonary Medicine FAMILY P RACTICE N EWS • August 15, 2007

Omalizumab Aids A Range of Problems Can Mimic Croup Asthmatics With BY GREG MUIRHEAD abatement of the cold. A history will re- cytomegalovirus retinitis in HIV patients. Contributing Writer veal the prior intubation that caused the Several studies have found “lasting re- Allergies to Cats situation, and there are surgical options mission in pediatric patients about 50% M AUI, HAWAII — All that appears to for treatment. of the time,” he said. “Lasting remission S AN F RANCISCO — Omalizumab, be croup is not, said Dr. Seth M. Pransky. Ǡ Congenital airway abnormalities. is 5 years without disease,” he added. when added to treatments, reduced The conditions mimicking croup range These include glottic webs, which tend to But the most important measure to the number of rescue bursts of corticos- from anatomical problems to gastroe- be thick and to extend to the subglottis. take in preventing RRP is for teroids in patients allergic to cat dander, sophageal reflux disease (GERD) to an in- They include the 22q deletion syndrome, HPV, he emphasized. Marc Massanari, Pharm.D., said in a poster fection contracted at birth, said Dr. Pran- which is associated with a variety of ab- Ǡ Gastroesophageal reflux disease presentation at the International Confer- sky, director of pediatric otolaryngology normalities, including speech abnormal- (GERD). The occurrence of nocturnal ence of the American Thoracic Society. at Rady Children’s Hospital, San Diego. ities. It’s a form of laryngeal atresia, an is the most important piece of clin- The omalizumab patients needed 25% They include the following: abnormality in the . There are ical information suggesting GERD. Ear- fewer puffs than those on placebo Ǡ Subglottic hemangioma. These pa- surgical options for treatment. nose-throat manifestations of and asso- and had a 100% increase in forced expira- tients “present with ‘croup’ at about 6 Ǡ Laryngeal clefts. These are associated ciations with GERD include of tory volume in 1 second (FEV1), compared weeks of age, but they have no , they with recurrent cough and aspiration infancy, recurrent otitis, chronic , with a 33% increase in placebo patients, have a good cry, and up until that point problems, he explained. “Clefts [classified , hoarseness, chronic cough (espe- both statistically significant differences. they’ve been eating pretty well,” he said as Veau I or II] can be treated endoscop- cially nocturnal), halitosis, laryn- The results came from a pooled popu- at a meeting sponsored by the University ically. Clefts [classified as Veau III] go into gospasm/apnea, severe , lation of 2,236 patients enrolled in five Childrens Medical Group and the Amer- the itself and require open sur- recurrent croup, , re- placebo-controlled clinical trials of omal- ican Academy of . “But they gical intervention.” current , and asthma. izumab. Dr. Massanari and his colleagues, come in with some respiratory difficulty.” Ǡ Recurrent respiratory papillomatosis Ǡ Eosinophilic esophagitis (EE). The all of whom are employed by Novartis These patients have a submucosal (RRP). The patient may have a history of symptoms of this disorder are similar to Pharmaceuticals Corp., East Hanover, N.J., mass, located beneath the , “asthma” or recurrent croup, but the cor- GERD but often do not respond to focused on the 1,589 patients with mod- most likely in the left posterolateral wall, rect diagnosis is usually identified at about GERD therapy. Adolescents who do not erate to severe and persistent IgE-mediat- he explained. Females are more likely to age 3 years, although this infection has have a history of a tracheoesophageal fis- ed asthma and who showed sensitivity to have it than are males, by a ratio of 3.5:1. been found in neonates. Ask about ma- tula but who gag on food or have swal- cat dander. Of those, 811 received omal- Management options include the use ternal vaginal condylomata, Dr. Pransky lowing problems may have EE, he said, izumab and 778 received placebo adminis- of , GERD therapy, and—in life- recommended. In preadolescent patients, “unless proven otherwise.” tered subcutaneously every 2 or 4 weeks. threatening cases only—vincristine, he especially girls, think about the possibili- “It’s very hard to treat; right now, the The omalizumab patients also had sig- said. Surgery is usually necessary and of- ty of sexual abuse, because this disease is only treatment is swallowed steroids,” he nificant decreases in rescue beta-agonist ten is done endoscopically. Open surgical caused by the human papillomavirus noted. He predicted that there would be puffs and showed significant improvements excision also can be performed. Rarely, (HPV). If the child was infected by the a patented product available for EE treat- in all domains of the Asthma Quality of tracheostomy is necessary. mother during delivery, keep in mind that ment within a year. Life Questionnaire. Novartis and Genen- Ǡ Postintubation glottic and subglot- the infection may clear from women Ǡ . A history may reveal this tech Inc. supported the study tic lesions. These may be caused by ei- within 2 years, and therefore may be ab- problem, along with x-rays and the pres- —Robert Finn ther long or quick intubations, he said at sent from the mother by the time the ence of a transient wheeze. The use of a the meeting, which was also sponsored physician finds the infection in the child. double-headed stethoscope allows the by California Chapter 2 of the AAP. The goals of treatment are to maintain physician to listen to both sides of the In the subglottis, mucous glands abrad- the airway and voice and to prevent the lungs at the same time and to check for Lean Smokers Face ed by intubation become obstructed and disease from spreading to the lungs, subtle differences suggestive of a foreign secrete heavily, creating a thick-walled where it can convert to a malignancy. Tra- body. “The critical issue for tracheal or air- A Greater Risk cyst, especially when the patient has a cheostomy is avoided because the site of way foreign bodies is history, history, his- cold; this causes . incision is where the is likely to go. tory,” said Dr. Pransky who disclosed that Of Lung Cancer “These patients present with stridor, A drug that may be helpful in patients he is on the speakers’ bureau for Merck typically when they have a cold,” he said. with RRP from HPV infection is cido- & Co.; he also conducts research with L OS A NGELES — High body mass in- The situation usually resolves with the fovir, which is approved for treatment of ArthroCare Corp. and Medtronic Inc. ■ dex is associated with a lower risk of lung cancer among smokers, Jian-Min Yuan, Ph.D., reported in a poster presentation at the annual meeting of the American As- Asthma Severity Tied to Home Improvements sociation for Cancer Research. The study involved a prospective, pop- BY KATE JOHNSON 12% required a high- ulation-based cohort of 63,257 middle- Montreal Bureau efficiency particulate Fewer Asthma Symptoms in Intervention Group aged and older Chinese men and women air filter, 10% re- Education/intervention group who were enrolled in the Singapore Chi- T ORONTO — Asthma symptoms im- quired a kitchen fan, (33 homes with 47 children) nese Health Study between 1993 and 1998. prove in children whose homes are re- and 15% required a 67% Education-only group Smokers with a body mass index (BMI) modeled to reduce triggers such as dust window fan. (23 homes with 34 children) of at least 28 kg/m2 had a 35% lower risk mites, mold, mice, and cockroaches, Dr. Compared with 48% of developing lung cancer than those with Megan Sandel reported in a poster pre- homes in the educa- a BMI below 20, wrote Dr. Yuan of the Uni- sentation at the annual meeting of the tion-only group, in- 38% versity of Minnesota, Minneapolis. The re- Pediatric Academic Societies. tervention homes sults were adjusted for potential con- Families were randomly assigned to re- showed lower mouse 21% 23% EWS founders, including age at enrollment, sex, ceive education plus an intervention (re- infestation scores (0.7 N number of cigarettes smoked daily, number modeling) or education only with the in- vs. 1.4). Similarly, 8% of years smoking or number of years since tervention delayed for 4 months. The bathroom mold im- EDICAL quitting smoking, and dietary intake of data were collected before the second proved from 17% to Stopped play Asthma Needed quick- M because of asthma symptoms relief

beta-cryptoxanthin and isothiocyanates. group received the intervention, ex- 8% after the interven- LOBAL G The inverse association between BMI plained Dr. Sandel of Boston University. tion, compared with Note: Based on data over a 2-week period. and lung cancer risk was strongest in cur- Among the 56 families with complete worsening in homes Source: Dr. Sandel LSEVIER rent smokers, much weaker in lifelong non- data representing 81 children with asth- with education only E smokers, and absent in former smokers. ma, home remodeling resulted in better (15% to 49%). The association was stronger in men than asthma outcomes, compared with edu- Over a 2-week period, the intervention tion over 2 weeks also was less in the in- in women. The investigators hypothesized cation only. In total, 78% of homes re- group also had fewer asthma symptoms tervention group, compared with the ed- that smoking may increase the metabolic quired integrated pest control for mice (23% vs. 38%) and fewer periods of ucation-alone group (48% vs. 67%); this rate that leads to high cellular production and cockroaches, 40% required carpet re- stopped play because of asthma (8% vs. represented a reduction of 10% in the in- of reactive species in lean smokers. moval to control dust mites, 36% re- 21%), compared with the education-only tervention group, compared with an 11% —Robert Finn quired a bathroom fan to control mold, group. The need for quick-relief medica- increase in the education group. ■