Mast Cell Activation Syndrome.
Abstract A 51-year-old woman with a history of asthma and Hashimoto's thyroiditis presented to the dermatology service with a chief complaint of "itchy bumpy rashes" that persisted beyond 24 hours. She noted that, 3 days prior to the onset of urticaria, a pyrroloquinoline quinone supplement had been started. The urticaria was accompanied by variable episodes of transient facial swelling and difficulty breathing. The patient noted that exposure to fish, nuts, and nonsteroidal anti-inflammatory drugs triggered facial swelling. Other reported findings included a 5-year history of diarrhea, sense of memory d...
Source: Skinmed - December 31, 2017 Category: Dermatology Authors: Kramer ON, Barkoff MS, Hernandez C Tags: Skinmed Source Type: research

Effect of Study Design on Sample Size in Studies Intended to Evaluate Bioequivalence of Inhaled Short-Acting β-Agonist Formulations.
Effect of Study Design on Sample Size in Studies Intended to Evaluate Bioequivalence of Inhaled Short-Acting β-Agonist Formulations. J Clin Pharmacol. 2017 Dec 27;: Authors: Zeng Y, Singh S, Wang K, Ahrens RC Abstract Pharmacodynamic studies that use methacholine challenge to assess bioequivalence of generic and innovator albuterol formulations are generally designed per published Food and Drug Administration guidance, with 3 reference doses and 1 test dose (3-by-1 design). These studies are challenging and expensive to conduct, typically requiring large sample sizes. We proposed 14 modified stud...
Source: The Journal of Clinical Pharmacology - December 27, 2017 Category: Drugs & Pharmacology Authors: Zeng Y, Singh S, Wang K, Ahrens RC Tags: J Clin Pharmacol Source Type: research

Don’t call me crazy! Delirium occurs outside of the intensive care unit
Introduction Delirium has been well studied among patients in the intensive care unit (ICU); however, data beyond the ICU is limited. The purpose of this study is to prospectively evaluate the incidence and associated risk factors for delirium in noncritical care areas (NCCA). Methods After institutional review board approval, a prospective cohort study was conducted at our urban Level I Trauma Center from December 2015 to February 2016. All patients admitted to the designated study area by a trauma surgeon were included. The Confusion Assessment Method (CAM) was administered every 12 hours until discharge. Delirious ...
Source: The Journal of Trauma: Injury, Infection, and Critical Care - December 26, 2017 Category: Orthopaedics Tags: WTA 2017 Plenary Paper Source Type: research

Myasthenia gravis with antibodies to MuSK: an update
Abstract Myasthenia gravis with antibodies to the muscle‐specific tyrosine kinase (MuSK+ MG) is a rare disease with distinctive pathogenic mechanisms and clinical features. An acute onset and predominant bulbar muscle weakness are very common and highly suggestive of the disease. On the other hand, a more indolent course, atypical ocular presentation, and signs of cholinergic hyperactivity may complicate the diagnosis. Though MuSK+ MG is still a severe disease, over the years we have observed a steady reduction in the rate of respiratory crisis and a significant improvement in the clinical outcome, both likely related to...
Source: Annals of the New York Academy of Sciences - December 21, 2017 Category: Science Authors: Amelia Evoli, Paolo E. Alboini, Valentina Damato, Raffaele Iorio, Carlo Provenzano, Emanuela Bartoccioni, Mariapaola Marino Tags: CONCISE REVIEW Source Type: research

A Controlled Trial of Inhaled Bronchodilators in Familial Dysautonomia
AbstractBackgroundChronic lung disease is a leading cause of premature death in patients with familial dysautonomia (FD). A significant number of patients have obstructive airway disease, yet it is not known whether this is pharmacologically reversible.MethodsWe conducted a double-blind, placebo-controlled, randomized clinical trial comparing the beta 2 agonist albuterol with the muscarinic blocker ipratropium bromide in patients homozygous for the IKBKAP founder mutation. Albuterol, ipratropium bromide, and placebo were administered on 3 separate days via nebulizer in the seated position. Airway responsiveness was evaluat...
Source: Lung - December 12, 2017 Category: Respiratory Medicine Source Type: research

Compared Aerosol Drug Delivery Efficacy of Two Types Nebulizer in Adult Mechanical Ventilator
Background: Aerosol drug delivery through mechanical ventilation (MV) is widely utilized for treating various respiratory disorders. The aim of the study was to compare our novel polymeric vibrating-mesh nebulizer (µMVN+) to currently used aerosol devices during MV.Methods: A ventilator (Puritan Bennet 760) was set to adult parameters (600 mL, 16 breaths/min) and connected via an endotracheal tube with a filter to a passive test lung. A unit dose of Ventolin (GSK) or Pulmicort (AstraZeneca) was individually added to µMVN+3.6 (median mass aerodynamic diameter (MMAD) of 3.6µm), µMVN+2.8 (MMAD of 2.8&m...
Source: European Respiratory Journal - December 6, 2017 Category: Respiratory Medicine Authors: Kao, Y.-y., Huang, C.-C., Hung, C.-S., Chen, E., Lin, H.-L. Tags: Airway Pharmacology and Treatment Source Type: research

Respiratory rehabilitation in children with severe asthma. Preliminary results
Conclusion: This study shows that PR is possible to carry out in severe asthmatic school children; showing improvement in quality of life, asthma control and lung function tests. (Source: European Respiratory Journal)
Source: European Respiratory Journal - December 6, 2017 Category: Respiratory Medicine Authors: Montes, S., Contreras, D., Ulloa, D., Martinez, P., Cerda, H. Tags: Paediatric Asthma and Allergy Source Type: research

Bronchoprotective tolerance with indacaterol is not modified by concomitant tiotropium in persistent asthma
Background: Tiotropium is a long acting antimuscarinic (LAMA), licensed as triple therapy with inhaled corticosteroid and long acting beta-agonist (ICS/LABA). There may be a synergistic benefit between LAMA and LABA as a consequence of receptor cross talk , which in turn could modify beta-2 receptor down-regulation and associated tolerance induced by LABA. We hypothesize these mechanisms may result in a reduction of airway hyperresponsiveness (AHR) when using triple therapy.Methods: We evaluated 14 non-smoking asthmatics using an open label, randomized crossover design. ICS with Tiotropium (TIO) and Indacaterol (IND) vs IC...
Source: European Respiratory Journal - December 6, 2017 Category: Respiratory Medicine Authors: Jabbal, S., Manoharan, A., Lipworth, B. Tags: Airway Pharmacology and Treatment Source Type: research

Particle size variation of nebulized albuterol occurs while traveling through neonatal mechanical ventilation circuits
Background: Vibrating mesh (VMN) and jet nebulizers (JN) placed in the ventilator circuit are used to deliver albuterol to pediatric patients receiving mechanical ventilation. We evaluated changes in aerosol characteristics that occur at different points of a neonatal circuit.Methods: A model consisting of a neonatal ventilator heated-wired circuit (internal diameter 11 mm/0.91 m long)/humidifier was set up. Three units of a VMN (bias flow 7 L/min) and JN (6 L/min + bias flow 1 L/min) loaded with albuterol sulfate solution (5mg/3.5ml) were operated for 4 min and tested with a cooled Next Generation Impactor with mixing inl...
Source: European Respiratory Journal - December 6, 2017 Category: Respiratory Medicine Authors: Berlinski, A., Kumaran, S. Tags: Neonatology and Paediatric Intensive Care Source Type: research

Method of volumetric capnography in the evaluation of small airway function in patients with asthma
The presence and severity of obstruction in patients with asthma is estimated with the help of the forced expiratory volume in the first second (FEV1) during spirometry. However, the use of this test does not provide information on the condition of the small airways, the result of the survey depends much on the efforts on the part of the patient, which limits its use in individuals of elderly age and senility, children.Aim: assessing capabilities of volumetric capnography in determining of small airway function in patients with asthma.Materials and Methods: the study involved 54 people of both sexes with a diagnosis of ast...
Source: European Respiratory Journal - December 6, 2017 Category: Respiratory Medicine Authors: Ponomareva, I., Abrosimov, V., Subbotin, S. Tags: Respiratory Function Technologists/Scientists Source Type: research

Time of maximal spirometric change after bronchodilator inhalation
Conclusion: Maximal spirometric changes after BD inhalation occur at times other than 1.0 sec. Alternative time points, where signals maximize, may increase sensitivity for determining BD responsiveness. (Source: European Respiratory Journal)
Source: European Respiratory Journal - December 6, 2017 Category: Respiratory Medicine Authors: Hegewald, M., Bomberg, S., Linares-Perdomom, O., Jensen, R., Morris, A. Tags: Respiratory Function Technologists/Scientists Source Type: research

Nocturnal hypoxaemia in COPD. Prevalence and clinical characteristics
Rationale: The prevalence, clinical features and impact of nocturnal hypoxemia (NH) in COPD patients have been inadequately characterized.Aim: To determine the prevalence and clinical impact of NH in COPD with non-hypoxaemia at rest.Methods: We analysed baseline data from the ongoing study "Spanish multicenter prospective cohort with multidimensional evaluation of COPD patients (COPD History Assessment In SpaiN (CHAIN)" (ClinicalTrials.gov: NCT01122758). COPD was defined by smoking history (>10 pack-years) and a post-bronchodilator FEV1 /FVC
Source: European Respiratory Journal - December 6, 2017 Category: Respiratory Medicine Authors: Marin Trigo, J. M., Marin-Oto, M., de Torres, J. P., Cabrera, C., Solanes, I., Martinez, C., Toledo, N., Peces-Barba, G., Amado, C., Vigil, L., Casanova, C. Tags: Clinical Problems COPD Source Type: research

Comparing asthma and COPD inhaler devices in real life clinical practice in the UK: differences in training requirements and preference
Background: Most patients use their inhaler devices incorrectly (Price et al Eur Respir J 2014), but many medical centres lack sufficient resources to train patients (pts).Aims/Objectives: To compare the time needed to achieve device mastery between Spiromax and other commonly prescribed inhalers, and to assess inhaler preferences.Methods: A cross-sectional observational study in asthma and COPD review clinics in the UK assessing pts using their current inhalers (DuoResp Spiromax, Symbicort Turbohaler, Advair Diskus [DPIs] or Ventolin Evohaler [pMDI]) [session 1], and 2 sequentially allocated alternative devices [session 2...
Source: European Respiratory Journal - December 6, 2017 Category: Respiratory Medicine Authors: Chrystyn, H., Benhaddi, H., van der Tol, M., Voorham, J., Haughney, J., Bosnic-Anticevich, S., Price, D., Roche, N. Tags: General Practice and Primary Care Source Type: research

Pressurized Metered Dose Inhaler (pMDI) Delivery to Infants via Valved Holding Chamber (VHC) with Facemask: Not All VHCs Perform the Same
Rationale: Delivery of inhaled medication to an infant from a pMDI via VHC-facemask is dependent upon the interaction between facemask and face of the patient. Using an anatomically accurate nasopharynx (ADAM-III) infant model we report the findings of clinically appropriate testing from several VHC facemask products used to deliver Ventolin.Methods: Each VHC (n=5 devices/group) was used according to manufacturer's instructions ensuring appropriate facemask application to the face model. Aerosol was collected at the carinal end of the model by a filter whilst being connected to a breathing simulator (ASL 5000) set to mimic...
Source: European Respiratory Journal - December 6, 2017 Category: Respiratory Medicine Authors: Bracey, A., Nagel, M., Suggett, J. Tags: Airway Pharmacology and Treatment Source Type: research

Further Studies of Unsuspected Emphysema in Non-Smoking Asthmatics with Persistent Expiratory Airflow Obstruction.
CONCLUSIONS: As documented now in 5 cases, unsuspected microscopic mild centrilobular emphysema is sentinel cause of loss of lung elastic recoil. This contributes significantly to expiratory airflow obstruction in never smoked asthmatics, with normal diffusing capacity and near-normal lung CT. PMID: 29197547 [PubMed - as supplied by publisher] (Source: Chest)
Source: Chest - November 29, 2017 Category: Respiratory Medicine Authors: Gelb AF, Yamamoto A, Verbeken EK, Schein MJ, Moridzadeh R, Tran D, Fraser C, Barbers R, Elatre W, Koss MN, Glassy EF, Nadel JA Tags: Chest Source Type: research

Recurrent Failure of Positive-Pressure Ventilation: Machine Malfunction or a Rare, Unexpected Cause?
A 64-YEAR-OLD MAN with a biopsy-proven ameloblastoma, a benign odontogenic neoplasm of the jaw,1 presented for a partial mandibulectomy. His medical history was significant for smoking, chronic obstructive pulmonary disease controlled with occasional albuterol inhaler use, and coronary artery disease treated with a coronary artery bypass graft and subsequent stent placement. His medications included aspirin, beta blockers, and nitrates. His functional capacity was greater than 4 metabolic equivalents, although he reported occasional shortness of breath on exertion. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - November 24, 2017 Category: Anesthesiology Authors: Ricardo Diaz Milian, Manuel R. Castresana Tags: Diagnostic Dilemma Source Type: research

The mouse passive ‐transfer model of MuSK myasthenia gravis: disrupted MuSK signaling causes synapse failure
Abstract While the majority of myasthenia gravis patients express antibodies targeting the acetylcholine receptor, the second most common cohort instead displays autoantibodies against muscle‐specific kinase (MuSK). MuSK is a transmembrane tyrosine kinase found in the postsynaptic membrane of the neuromuscular junction. During development, MuSK serves as a signaling hub, coordinating the alignment of the pre‐ and postsynaptic components of the synapse. Adult mice that received repeated daily injections of IgG from anti‐MuSK+ myasthenia gravis patients developed muscle weakness, associated with neuromuscular transmiss...
Source: Annals of the New York Academy of Sciences - November 10, 2017 Category: Science Authors: Nazanin Ghazanfari, Sofie Trajanovska, Marco Morsch, Simon X. Liang, Stephen W. Reddel, William D. Phillips Tags: CONCISE REVIEW Source Type: research

Heart Rate Variability Biofeedback Does Not Substitute for Asthma Steroid Controller Medication
AbstractDespite previous findings of therapeutic effects for heart rate variability biofeedback (HRVB) on asthma, it is not known whether HRVB can substitute either for controller or rescue medication, or whether it affects airway inflammation. Sixty-eight paid volunteer steroid na ïve study participants with mild or moderate asthma were given 3 months of HRVB or a comparison condition consisting of EEG alpha biofeedback with relaxing music and relaxed paced breathing (EEG+), in a two-center trial. All participants received a month of intensive asthma education prior to rand omization. Both treatment conditions p...
Source: Applied Psychophysiology and Biofeedback - November 9, 2017 Category: Psychiatry Source Type: research

Heart Rate Variability Biofeedback Does Not Substitute for Asthma Steroid Controller Medication.
Abstract Despite previous findings of therapeutic effects for heart rate variability biofeedback (HRVB) on asthma, it is not known whether HRVB can substitute either for controller or rescue medication, or whether it affects airway inflammation. Sixty-eight paid volunteer steroid naïve study participants with mild or moderate asthma were given 3 months of HRVB or a comparison condition consisting of EEG alpha biofeedback with relaxing music and relaxed paced breathing (EEG+), in a two-center trial. All participants received a month of intensive asthma education prior to randomization. Both treatment cond...
Source: Applied Psychophysiology and Biofeedback - November 9, 2017 Category: Psychiatry & Psychology Authors: Lehrer PM, Irvin CG, Lu SE, Scardella A, Roehmheld-Hamm B, Aviles-Velez M, Graves J, Vaschillo EG, Vaschillo B, Hoyte F, Nelson H, Wamboldt FS Tags: Appl Psychophysiol Biofeedback Source Type: research

Safety of Nebulized Epinephrine in Smoke Inhalation Injury
This pilot study was conducted to profile safety of nebulized racemic epinephrine when used as a therapy for smoke inhalation injury in severely burned children. We enrolled 16 patients who were 7 to 19 years of age ([mean ± SD], 12 ± 4 years) with burns covering more than 30% of the TBSA (55 ± 17%) and smoke inhalation injury, as diagnosed by bronchoscopy at burn center admission. Patients were randomized to receive either standard of care (n = 8), which consisted of nebulized acetylcysteine, nebulized heparin, and nebulized albuterol, or to receive standard of care plus ne...
Source: Journal of Burn Care and Research - November 1, 2017 Category: Rehabilitation Tags: Original Articles Source Type: research

Presynaptic congenital myasthenic syndrome with altered synaptic vesicle homeostasis linked to compound heterozygous sequence variants in RPH3A
ConclusionIn summary, we report a patient with a multisystem neurologic disorder and altered SV regulation attributed to defects in RPH3A, which grants further studies of this gene in human disorders of synaptic transmission. We report a patient with a complex phenotype characterized by failure of neuromuscular transmission, tremors and learning disabilities whose motor nerve terminals showed signs of disruptive synaptic vesicle homeostasis. The condition is attributed to sequence variants in RPH3A that alter both exocytosis and downstream endocytosis and synaptic vesicle recycling. The condition shows a favorable respons...
Source: Molecular Genetics & Genomic Medicine - November 1, 2017 Category: Genetics & Stem Cells Authors: Ricardo A. Maselli, Jessica V ázquez, Leah Schrumpf, Juan Arredondo, Marian Lara, Jonathan B. Strober, Peter Pytel, Robert L. Wollmann, Michael Ferns Tags: CLINICAL REPORT Source Type: research

P028 Reaction to lactose in an albuterol sulfate dry powder inhaler training device
We describe a reaction to lactose in the albuterol sulfate (ProAir Respiclick) training device, which contains lactose but does not contain active medication. (Source: Annals of Allergy, Asthma and Immunology)
Source: Annals of Allergy, Asthma and Immunology - October 27, 2017 Category: Allergy & Immunology Authors: P. Maini, M. Makhija Source Type: research

P236 Comorbidities associated with poor short-acting beta-agonist inhaler handling among united states respiratory patients
This study evaluated the prevalence of comorbidities potentially affecting device handling in asthma and/or COPD patients using SABAs, including albuterol multidose dry powder inhaler (MDPI), the only MDPI not requiring hand-breath coordination. (Source: Annals of Allergy, Asthma and Immunology)
Source: Annals of Allergy, Asthma and Immunology - October 27, 2017 Category: Allergy & Immunology Authors: K. Ramakrishnan, B. Chipps, E. Parker, R. Ariely, R. Parikh, S. Stoyanov Source Type: research

Occupational exposure and asthma control
In this issue of the European Respiratory Journal, Dumas et al. [1] describe associations between occupational disinfectant exposure and asthma control in US nurses. Asthma control was defined by using the Asthma Control Test (ACT) and based on responses to five questions on activity limitations, frequency of symptoms and frequency of use of quick-relief medication in the past 4 weeks (β-agonist inhaler, e.g. albuterol, for symptom control). This instrument is not commonly considered an end-point in studies on occupational exposures and asthma, while asthma control is of particular relevance for asthma patients a...
Source: European Respiratory Journal - October 26, 2017 Category: Respiratory Medicine Authors: Heederik, D. Tags: Epidemiology, occupational and environmental lung disease, Asthma and allergy Editorials Source Type: research

National Characteristics of Emergency Medical Services Responses for Older Adults in the United States.
Authors: Duong HV, Herrera LN, Moore JX, Donnelly J, Jacobson KE, Carlson JN, Mann NC, Wang HE Abstract OBJECTIVE: Older adults, those aged 65 and older, frequently require emergency care. However, only limited national data describe the Emergency Medical Services (EMS) care provided to older adults. We sought to determine the characteristics of EMS care provided to older adults in the United States. METHODS: We used data from the 2014 National Emergency Medical Services Information System (NEMSIS), encompassing EMS response data from 46 States and territories. We excluded EMS responses for children
Source: Prehospital Emergency Care - September 3, 2017 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

Agreement Between Maternal Report and Medical Records During Pregnancy: Medications for Rheumatoid Arthritis and Asthma
ConclusionsAgreement was higher for medications typically used continuously than sporadically. Information on medication use from medical records alone may not be adequate when studying the impact of intermittently used medications during pregnancy on perinatal outcomes. (Source: Paediatric and Perinatal Epidemiology)
Source: Paediatric and Perinatal Epidemiology - September 1, 2017 Category: Perinatology & Neonatology Authors: Kristin Palmsten, Avanthi Hulugalle, Gretchen Bandoli, Grace M. Kuo, Shayda Ansari, Ronghui Xu, Christina D. Chambers Tags: Original Article Source Type: research

Comparison Table: Correct Use of Inhalers for Asthma (online only)
Date: August 28, 2017 Issue #:  1528Summary:  View the Comparison Table: Correct Use of Inhalers (Source: The Medical Letter)
Source: The Medical Letter - August 22, 2017 Category: Drugs & Pharmacology Authors: admin Tags: Advair Aerospan AirDuo Albuterol Alvesco ArmonAir Asmanex Asthma Atrovent Beclomethasone dipropionate Breo Ellipta Budesonide/formoterol ciclesonide Dulera Flovent Flunisolide fluticasone furoate Fluticasone propionate Source Type: research

Assessing the Impact of a Remote Digital Coaching Engagement Program on Patient Reported Outcomes in Asthma.
CONCLUSION: A patient-oriented, remote digital coaching program that utilized trained health coaches and digital materials led to statistically significant improvement in mental status, outpatient exacerbations, body weight, and ASUI. Digital coaching programs may improve some outcomes in adults with uncontrolled asthma. PMID: 28800273 [PubMed - as supplied by publisher] (Source: Journal of Asthma)
Source: Journal of Asthma - August 13, 2017 Category: Respiratory Medicine Tags: J Asthma Source Type: research

Reply
Longo et  al1 raise an interesting issue regarding the differentiation of eosinophilic asthma that may be nonatopic in nature. As indicated in our study, the likelihood of a favorable response to daily inhaled corticosteroid therapy in young children with emerging asthma was associated with either a blood e osinophil count of greater than or equal to 300 cells/mm3 or allergic sensitization as defined by multiallergen testing.2 The combination of these 2 features enhanced the likelihood of a favorable response as compared with our other 2 treatment strategies, either daily oral montelukast or inhaled c orticostero...
Source: Journal of Allergy and Clinical Immunology - August 3, 2017 Category: Allergy & Immunology Authors: Anne M. Fitzpatrick, Daniel J. Jackson, David Mauger, Stanley J. Szefler Tags: Correspondence Source Type: research

An Unusual Presentation after Crack Cocaine Use
BY ​SEMERE TEDLA, MD; WESLEY EILBERT, MD; & JOSEPH COLLA, MD​A 59-year-old man with a history of frequent crack cocaine use presented with difficulty breathing for four hours. He had no prior medical problems or known allergies. He admitted to smoking crack cocaine four days before his symptoms began. He reported a one-day history of productive cough but denied chest pain, sore throat, and fever.​​He was a well-developed man in mild distress. His temperature was 36.5°C, pulse 90 bpm, blood pressure 188/108 mm Hg, and respiratory rate 20 bpm. His oxygen saturation was 100% on four liters by nasal cannula. In...
Source: The Case Files - July 12, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: research

Effect of extending the time after bronchodilator administration on identifying bronchodilator responsiveness in a pediatric pulmonary clinic
Abstract ObjectivesAmerican Thoracic Society/European Respiratory Society (ATS/ERS) spirometry interpretation guidelines recommend ≥15 min between pre‐ and post‐bronchodilator testing to evaluate for a bronchodilator response. We aimed to lengthen the time between albuterol administration and post‐bronchodilator testing to adhere to ATS/ERS guidelines and evaluated if lengthening this wait time would increase the percentage of patients classified as bronchodilator responsive. MethodsWe compared the proportion of patients with a positive bronchodilator response between two groups of children with asthma, one...
Source: Pediatric Pulmonology - July 3, 2017 Category: Respiratory Medicine Authors: Jonathan D. Cogen, Robert M. DiBlasi, Ronald L. Gibson, Jason S. Debley Tags: ORIGINAL ARTICLE: ASTHMA Source Type: research

Retrospective Evaluation of Risk Factors for Pediatric Secondary Transport.
CONCLUSIONS: Children with seizures, isolated orthopedic injuries, and asthma/respiratory distress comprised the majority of the medical or minor trauma pediatric secondary transport population. Each of those conditions had specific risk factors for secondary transport. This study's results provide information to guide future prospective studies and the development of direct transport protocols for those populations. PMID: 28657816 [PubMed - as supplied by publisher] (Source: Prehospital Emergency Care)
Source: Prehospital Emergency Care - June 30, 2017 Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research

38-Year-Old Man With Asthma and Eosinophilia
A 38-year-old man with a history of asthma, depression, and anxiety presented with a 3-year history of recurrent dyspnea and wheezing. He had previously been active with his local ice hockey team and had no respiratory symptoms. On presentation, he reported frequent nighttime waking, dyspnea on minimal exertion, and frequent (6-10 times daily) albuterol rescue inhaler use. He noted marked worsening of his symptoms over the preceding 9 months and had been taking continuous oral steroids for the preceding 6 months. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - June 23, 2017 Category: Internal Medicine Authors: Carl Andersen, Hemang Yadav, Vivek N. Iyer Tags: Residents' Clinic Source Type: research

Influence of Formulation Factors on the Aerosol Performance of Suspension and Solution Metered Dose Inhalers: A Systematic Approach
AbstractMetered dose inhalers (MDIs) are complex drug-device combination products widely used to treat pulmonary disorders. The efficacy, driven by aerosol performance of the products, depends on a multitude of factors including, but not limited to, the physicochemical properties of drug and nature and amount of excipient(s). Under the quality by design (QbD) paradigm, systematic investigations are necessary to understand how changes in critical quality attributes (CQAs) of formulation, device, and manufacturing process influence key product performance parameters, such as delivered dose (DD) and fine particle dose (FPD). ...
Source: The AAPS Journal - June 7, 2017 Category: Drugs & Pharmacology Source Type: research

Not so obvious: acute herpes esophagitis
The gross examination immediately suggested infection with Candida species, but biopsy results pointed to a different culprit. A 29-year-old woman sought care in the emergency department after experiencing sharp epigastric pain over 2 days. She was initially seen at an urgent care center and empirically treated for gastritis with omeprazole. However, her pain progressively worsened and was accompanied by vomiting, prompting her hospital visit. Her past medical history included mild intermittent asthma, which was treated with albuterol, and morbid obesity, for which she had undergone gastric sleeve surgery. (Source: The Ame...
Source: The American Journal of Medicine - June 7, 2017 Category: General Medicine Authors: Yuji Yamada, Carlos Rodriguez, Abul Ala Syed Rifat Mannan, Matthew Harrington Tags: Diagnostic Dilemma Source Type: research

Discriminating Ability of Abbreviated Impactor Measurement Approach (AIM) to Detect Changes in Mass Median Aerodynamic Diameter (MMAD) of an Albuterol/Salbutamol pMDI Aerosol.
This article reports on results from a two-lab, multiple impactor experiment evaluating the abbreviated impactor measurement (AIM) concept, conducted by the Cascade Impaction Working Group of the International Pharmaceutical Aerosol Consortium on Regulation and Science (IPAC-RS). The goal of this experiment was to expand understanding of the performance of an AIM-type apparatus based on the Andersen eight-stage non-viable cascade impactor (ACI) for the assessment of inhalation aerosols and sprays, compared with the full-resolution version of that impactor described in the pharmacopeial compendia. The experiment was conduct...
Source: AAPS PharmSciTech - June 6, 2017 Category: Drugs & Pharmacology Authors: David Christopher J, Patel RB, Mitchell JP, Tougas TP, Goodey AP, Quiroz J, Andersson PU, Lyapustina S Tags: AAPS PharmSciTech Source Type: research

Airway smooth muscle dysfunction in Pompe (Gaa-/-) mice
Pompe disease is an autosomal recessive disorder caused by a deficiency of acid α-glucosidase (GAA), an enzyme responsible for hydrolyzing lysosomal glycogen. Deficiency of GAA leads to systemic glycogen accumulation in the lysosomes of skeletal muscle, motor neurons, and smooth muscle. Skeletal muscle and motor neuron pathology are known to contribute to respiratory insufficiency in Pompe disease, but the role of airway pathology has not been evaluated. Here we propose that GAA enzyme deficiency disrupts the function of the trachea and bronchi and this lower airway pathology contributes to respiratory insufficiency ...
Source: AJP: Lung Cellular and Molecular Physiology - June 1, 2017 Category: Respiratory Medicine Authors: Keeler, A. M., Liu, D., Zieger, M., Xiong, L., Salemi, J., Bellve, K., Byrne, B. J., Fuller, D. D., ZhuGe, R., ElMallah, M. K. Tags: RESEARCH ARTICLE Source Type: research

Comparison of a rapid albuterol pathway with a standard pathway for the treatment of children with a moderate to severe asthma exacerbation in the emergency department.
CONCLUSION: A rapid albuterol treatment pathway that utilizes a breath-enhanced nebulizer is an effective alternative to traditional pathways that utilize continuous nebulizations for children with moderate to severe asthma exacerbations in the ED. PMID: 28548898 [PubMed - as supplied by publisher] (Source: Journal of Asthma)
Source: Journal of Asthma - May 28, 2017 Category: Respiratory Medicine Tags: J Asthma Source Type: research

Granulomatosis with polyangiitis (GPA) presenting as thick-walled cavitary lung lesion
A 58-year-old female with a history of psoriatic arthritis on immunosuppressive therapy presented to the clinic with flu-like symptoms, cough, and blood-tinged sputum for one week. She denied chills, night sweats, wheezing, chest pain, weight loss, joint pain, or muscle aches. She had smoked for 31 pack-years and quit 1  year earlier. She was born and lived in upstate New York with no previous exposure to tuberculosis (TB). She had no exposure to chemicals or bird or bat droppings. There was no recent history of travel to any fungal endemic areas. Her home medications included albuterol, fluticasone-salmeterol, m on...
Source: QJM - May 26, 2017 Category: Internal Medicine Source Type: research

Real-world healthcare utilization in asthma patients using albuterol sulfate inhalation aerosol (ProAir & reg; HFA) with and without integrated dose counters
(Source: Journal of Asthma and Allergy)
Source: Journal of Asthma and Allergy - May 17, 2017 Category: Allergy & Immunology Tags: Journal of Asthma and Allergy Source Type: research

Benzalkonium Chloride: A Bronchoconstricting Preservative in Continuous Albuterol Nebulizer Solutions
For convenience, many pediatric hospitals are preparing solutions for continuous nebulized albuterol using the 0.5% 20‐ml multidose albuterol dropper bottle. This product contains benzalkonium chloride (BAC) that, by itself, produces bronchospasm that is dose dependent and cumulative. The bronchoconstrictive effects of BAC are greater in patients with more severe airway obstruction and increased airway responsiveness. Use of BAC‐containing albuterol during severe acute asthma exacerbations may antagonize the bronchodilator response to albuterol, prolong treatment, and increase the risk of albuterol‐related systemic a...
Source: Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy - May 9, 2017 Category: Drugs & Pharmacology Authors: Sreekala Prabhakaran, Mutasim Abu ‐Hasan, Leslie Hendeles Tags: Practice Insights Source Type: research

A novel approach to study the pMDI plume using an infrared camera and to evaluate the aerodynamic properties after varying the time between actuations
Publication date: 30 June 2017 Source:International Journal of Pharmaceutics, Volume 526, Issues 1–2 Author(s): Nitesh K. Kunda, Julia Hautmann, Sebastián E. Godoy, Patricia Marshik, Ramesh Chand, Sanjay Krishna, Pavan Muttil Plume characteristics, such as temperature and velocity, emitted from pMDIs could significantly affect the dose delivered to the lung. Currently, high speed cameras and thermocouples are used separately to evaluate these parameters. We used a low-noise infrared camera to evaluate both the temperature and velocity of the emitted plume from pMDIs. Additionally, we investigated whether the ...
Source: International Journal of Pharmaceutics - May 2, 2017 Category: Drugs & Pharmacology Source Type: research

Higher mini-BAL total protein concentration in early ARDS predicts faster resolution of lung injury measured by more ventilator-free days
The protein concentration of alveolar edema fluid in acute respiratory distress syndrome (ARDS) is dynamic. It reflects alveolar flooding during acute injury, as well as fluid and protein clearance over time. We hypothesized that among ARDS patients treated with low tidal volume ventilation, higher concentrations of protein in mini-bronchoalveolar lavage (mBAL) samples would predict slower resolution of lung injury and worse clinical outcomes. Total protein and IgM concentrations in day 0 mBAL samples from 79 subjects enrolled in the aerosolized albuterol (ALTA) ARDS Network Albuterol Trial were measured by colorimetric as...
Source: AJP: Lung Cellular and Molecular Physiology - May 1, 2017 Category: Respiratory Medicine Authors: Hendrickson, C. M., Abbott, J., Zhuo, H., Liu, K. D., Calfee, C. S., Matthay, M. A., NHLBI ARDS Network Tags: RESEARCH ARTICLE Source Type: research

Albuterol as an adjunctive treatment to enzyme replacement therapy in infantile-onset Pompe disease
Conclusions The results of our study suggest that albuterol showed a good safety profile as an adjunctive treatment in our IOPD cohort, although the benefits are limited. (Source: Molecular Genetics and Metabolism Reports)
Source: Molecular Genetics and Metabolism Reports - April 26, 2017 Category: Genetics & Stem Cells Source Type: research

Pneumonitis as an early complication of alemtuzumab treatment (P5.406)
Conclusions:Pneumonitis, while rare, resolves with corticosteroids and may occur earlier in the course of alemtuzumab treatment than previously suspected. Despite pneumonitis, patients’ MS may remain under good control.Disclosure: Dr. Kantor has received personal compensation for activities with Avanir, Bayer, Biogen, EMD Serono, Abbvie, Genzyme, Malinckrodt, Novartis, Otsuka, and Sandoz as consulting services and/or speakig honoraria. Dr. Steingo has received personal compensation for activities with Biogen, TEVA, Novartis, EMD Serono, Acorda, Sanofi Genzyme, Mallinckrodt as as speaker and/or advisor. Dr. Steingo ha...
Source: Neurology - April 17, 2017 Category: Neurology Authors: Kantor, D., Steingo, B. Tags: Disease Modifying Therapy for Multiple Sclerosis: Risk Assessment and Safety Source Type: research

Benzalkonium chloride; a bronchoconstricting preservative in continuous albuterol nebulizer solutions
ConclusionWe recommend that only preservative‐free albuterol products be used.This article is protected by copyright. All rights reserved. (Source: Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy)
Source: Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy - March 28, 2017 Category: Drugs & Pharmacology Authors: Sreekala Prabhakaran, Mutasim Abu ‐Hasan, Leslie Hendeles Tags: Practice Insights Source Type: research

Paradoxical bronchospasm from benzalkonium chloride (BAC) preservative in albuterol nebulizer solution in a patient with acute severe asthma. A case report and literature review of airway effects of BAC
We report a case of a 17 years old patient, who received 32 mg of BAC via nebulization over a period of 3.5 days that probably caused persistent bronchospasm evidenced by failure to improve clinically and to increase peak expiratory flow rate (PEFR) from 125 L/min (27% of predicted value) to 300 L/min (68% of predicted value) within 2 hours of withdrawing BAC. The patient's respiratory status and PEFR improved dramatically once the nebulization solution was switched to BAC free lev-albuterol solution. The pediatric providers, particularly the emergency department physicians, intensivists and pulmonologists need to be aware...
Source: Respiratory Medicine Case Reports - March 27, 2017 Category: Respiratory Medicine Source Type: research