Pneumomediastinum from a severe asthma attack

Journal of the American Academy of Physician Assistants:

July 2013 - Volume 26 - Issue 7 - p 29–32

doi: 10.1097/01.JAA.0000431512.13196.f3

Case Report

Pneumomediastinum from a severe asthma attack

Hashim, Taimoor MD, MB.BS; Chaudry, Ayesha H. MB.BS; Ahmad, Khurram MD; Imhoff, Jennifer PA-C; Khouzam, Rami MD, FACC, FACP, FASNC, FASE, FSCAI

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Author Information

Taimoor Hashim is a hospitalist at Highline Medical Center in Burien, Washington. Ayesha Chaudry is a clinical observer at Highline Medical Center. Khurram Ahmad is an interventional cardiology fellow and clinical instructor at Michigan State University in East Lansing, Michigan. Jennifer Imhoff is a PA in emergency medicine at Highline Medical Center. Rami Khouzam is an assistant professor of medicine in the division of cardiology at the University of Tennessee Health Sciences Center in Memphis, Tennessee. The authors have indicated no relationships to disclose relating to the content of this article.

Abstract

ABSTRACT: Spontaneous pneumomediastinum is a rare complication of an asthma exacerbation characterized by chest pain, dyspnea, neck swelling, and subcutaneous emphysema. Although the condition is usually benign and treatment is primarily supportive, surgical intervention may be needed if the patient develops hemodynamic or respiratory failure.

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Congenital erythrodermic psoriasis with atopic dermatitis: An example of immunogenetic spinoff

LETTER TO EDITOR

Year : 2013  |  Volume : 56  |  Issue : 1  |  Page : 72-73

Congenital erythrodermic psoriasis with atopic dermatitis: An example of immunogenetic spinoff

K Parimalam1, Jayakar Thomas2 1 Department of Dermatology, Stanley Medical College, Chennai, India 2 Department of Dermatology, Skin and STD, Sree Balaji Medical College and Hospital, Bharath University, Chennai, Tamil Nadu, India Click here for correspondence address and email Date of Web Publication 6-Aug-2013

How to cite this article: Parimalam K, Thomas J. Congenital erythrodermic psoriasis with atopic dermatitis: An example of immunogenetic spinoff. Indian J Pathol Microbiol 2013;56:72-3

Thorax doi:10.1136/thoraxjnl-2012-202878

• Chronic obstructive pulmonary disease

• Original article

Airway gene expression in COPD is dynamic with inhaled corticosteroid treatment and reflects biological pathways associated with disease activity

1. Maarten van den Berge1,2, 
2. Katrina Steiling3, 
3. Wim Timens4,2, 
4. Pieter S Hiemstra5,
5. Peter J Sterk6, 
6. Irene H Heijink1,2, 
7. Gang Liu3, 
8. Yuriy O Alekseyev7, 
9. Marc E Lenburg3,
10. Avrum Spira3, 
11. Dirkje S Postma1,2

+Author Affiliations

1. ¹Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
2. ²GRIAC (Groningen Research Institute for Asthma and COPD), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
3. ³Division of Computational Biomedicine, Department of medicine, Boston University School of Medicine, Boston, Massachusetts, USA
4. ⁴Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
5. ⁵Department of Pulmonary Diseases, Leiden University Medical Center, Leiden, The Netherlands
6. ⁶Department of Respiratory Medicine, F5-259, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
7. ⁷Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, USA

1. Correspondence toDr M van den Berge, Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen 9700 RB, The Netherlands;m.van.den.berge@umcg.nl

• Received 16 October 2012
• Revised 4 June 2013
• Accepted 30 June 2013
• Published Online First 7 August 2013

Abstract

Background A core feature of chronic obstructive pulmonary disease (COPD) is the accelerated decline in forced expiratory volume in one second (FEV₁). The recent Groningen and Leiden Universities study of Corticosteroids in Obstructive Lung Disease (GLUCOLD) study suggested that particular phenotypes of COPD benefit from fluticasone±salmeterol by reducing the rate of FEV₁ decline, yet the underlying mechanisms are unknown.

Methods Whole-genome gene expression profiling using the Affymetrix Gene ST array (V.1.0) was performed on 221 bronchial biopsies available from 89 COPD patients at baseline and after 6 and 30 months of fluticasone±salmeterol and placebo treatment in GLUCOLD.

Results Linear mixed effects modelling revealed that the expression of 138 genes decreased, whereas the expression of 140 genes significantly upregulated after both 6 and 30 months of treatment with fluticasone±salmeterol versus placebo. A more pronounced treatment-induced change in the expression of 50 and 55 of these 278 genes was associated with a lower rate of decline in FEV₁ and Saint George Respiratory Questionnaire, respectively. Genes decreasing with treatment were involved in pathways related to cell cycle, oxidative phosphorylation, epithelial cell signalling, p53 signalling and T cell signalling. Genes increasing with treatment were involved in pathways related to focal adhesion, gap junction and extracellular matrix deposition. Finally, the fluticasone-induced gene expression changes were enriched among genes that change in the airway epithelium in smokers with versus without COPD in an independent data set.

Conclusions The present study suggests that gene expression in biological pathways of COPD is dynamic with treatment and reflects disease activity. This study opens the gate to targeted and molecular phenotype-driven therapy of COPD.

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This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:http://creativecommons.org/licenses/by-nc/3.0/

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International Journal of Chronic Obstructive Pulmonary Disease

Drugs potentially affecting the extent of airways reversibility on pulmonary function testing are frequently consumed despite guidelines

Original Research

(26) Total Article Views

Authors: Jones TE, Southcott A, Homan S

Published Date August 2013 Volume 2013:8 Pages 383 - 388

DOI: http://dx.doi.org/10.2147/COPD.S44612

Received:	28 February 2013
Accepted:	12 April 2013
Published:	09 August 2013

Terry E Jones,¹ AnneMarie Southcott,² Sean Homan<sup>3

1</sup>Pharmacy Department, The Queen Elizabeth Hospital, Woodville South, SA, ²Respiratory and Sleep Medicine, Western Health, Footscray, VIC, ³Respiratory Unit, The Queen Elizabeth Hospital, Woodville South, SA, Australia

Background: The increase in forced expiratory volume in one second (FEV₁) effected by a bronchodilator is routinely assessed when patients undertake pulmonary function testing (PFT). Several drug classes can theoretically affect the magnitude of the increase in FEV₁. Withholding periods are advised for many but not all such drugs. Anecdotally, many subjects presenting for PFT are found to have taken drugs that might affect the test. We did an audit of patients presenting for PFT to assess the frequency with which FEV₁ reversibility might be affected by drugs.
Methods: One hundred subjects presenting to the laboratory for PFT were questioned about recent drug consumption by an independent pharmacy intern. Reversibility of FEV₁ was assumed to have been affected if drugs of interest were consumed within defined withholding periods or two half-lives for drugs without such data.
Results: Sixty-three subjects were prescribed drugs likely to affect FEV₁ reversibility. Thirty-six subjects consumed at least one such drug within the withholding period. Half (18) of these patients consumed β-blockers with or without β-agonists. Sixty-five subjects did not recall receiving any advice about withholding drugs prior to the test and only 10 recalled receiving advice from their clinician or pulmonary function technician.
Conclusion: Subjects presenting for PFT are infrequently advised to withhold drugs that may affect FEV₁ reversibility, and consequently, often take such drugs close to the time of the test. Therefore, it is likely that the increase in FEV₁ is frequently affected by interference from drugs and this might impact on diagnosis and/or treatment options.

Keywords: lung function tests, beta-adrenergic agonists, beta-adrenergic antagonists, withholding periods, bronchodilators



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