Quality-Improvement Project Cuts Albuterol Use in Kids With Bronchiolitis Quality-Improvement Project Cuts Albuterol Use in Kids With Bronchiolitis
Changes in clinical pathways and order sets can help reduce albuterol use in children with bronchiolitis, researchers report.Reuters Health Information
Publication date: Available online 4 April 2020Source: Respiratory Medicine Case ReportsAuthor(s): Chika Yajima, Nariaki Kokuho, Kazutoshi Toriyama, Junichiro Kawagoe, Yuki Togashi, Jun Matsubayashi, Hideaki Nakayama, Yasuhiro Setoguchi, Shinji Abe
Condition: Bronchiolitis Interventions: Other: Hypertonic solution; Other: Physiological solution Sponsors: Guadarrama Hospital; Fisiobronquial Clínicas Not yet recruiting
Bronchiolitis obliterans syndrome (BOS), the most common form of chronic lung allograft dysfunction (CLAD), and the major limitation to long-term survival after lung transplantation. BOS affects up to 50% of lung transplant recipients within 5 years after transplant, causing significant morbidity and mortality. BOS manifesting early after transplantation shows a poorer prognosis than late ‐onset BOS. There are only few studies assessing treatment efficacy, but only a minority of patients respond to current treatment options.
Airway epithelial injury is thought to be a key event in the pathogenesis of CLAD. We investigated whether markers of epithelial activation and injury in bronchoalveolar lavage (BAL) correlate with CLAD diagnosis and the major CLAD phenotypes: bronchiolitis obliterans syndrome (BOS) vs. restrictive allograft syndrome (RAS) / mixed phenotype.
The objective of the current study was to assess the diagnostic accuracy of FVC≤80% for determining RAS/Mixed in a large center that routinely monito rs both TLC and FVC.
Respiratory tract infection with respiratory syncytial virus (RSV), human metapneumo virus (hMPV) or parainfluenza virus (PIV) are increasingly associated with chronic lung allograft dysfunction in the form of bronchiolitis obliterans syndrome (BOS) in lung transplant recipients (LTR). Ribavirin as treatment option is under debate since its effectiveness is unclear, especially in light of infection severity.
Bronchiolitis obliterans (BOS) remains a major cause of death for lung transplant recipients, and mechanisms that drive BOS remain poorly understood. Genetically encoded deficiencies in mitophagy, a specialized autophagy that targets the removal of damaged mitochondria, have been shown to promote Parkinson's disease, but it is unclear if they play a role in other chronic diseases. Recent work has shown that the rs2241880 mutation in the autophagy regulator ATG16L1 leads to protein instability resulting in deficiency of ATG16L1 in monocyte-derived macrophages.
The optimal immunosuppressive (IS) regimen after lung (LU) transplant is unknown, therefore we sought to examine OPTN data to compare the impact of 4 different IS combinations on outcomes of treated acute rejection (AR), bronchiolitis obliterans syndrome (BOS), and graft survival.
The long-term survival after lung transplantation remains limited, mostly because of Chronic Lung Allograft Dysfunction (CLAD), which has two different phenotypes: bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome (RAS). Our tools for assessing lung allograft cells are limited by the autofluorescence of the lung tissue. We aimed to assess CLAD lung allografts using imaging mass cytometry (IMC), a mass spectroscopic technology that allows high-resolution, multi-dimensional characterization of lung cell surface and intracellular proteins at a single cell level, using heavy metal-tagged antibodies.
Chronic lung allograft dysfunction (CLAD) remains the major obstacle to long-term survival after lung transplantation. Two different phenotypes have recently been described. About 80% of patients have primarily obstructive lung disease associated with obliterative bronchiolitis, airway fibrosis with intraluminal narrowing (OB-CLAD) while a smaller subset has lung restriction with hypoxemia and parenchymal fibrosis (R-CLAD). Preclinical modeling is essential to better analyze the pathophysiological processes leading to CLAD development.