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Anderson S.D.,Respiratory and Sleep Medicine | Kippelen P.,Brunel University
British Journal of Sports Medicine

The assessment of exercise-induced bronchoconstriction (EIB) in athletes requires the measurement of forced expiratory volume in 1 s (FEV1) before and after vigorous exercise or a surrogate of exercise such as eucapnic voluntary hyperpnoea (EVH) of dry air or mannitol dry powder. Exercise testing in a laboratory has a low sensitivity to identify EIB, and exercise testing in the field can be a challenge in itself particularly in cold weather athletes. The EVH test requires the subject to ventilate dry air containing ∼5% CO 2 for 6 min through a low-resistance circuit at a rate higher than that usually achieved on maximum exercise. A>10% reduction in FEV 1 is a positive response to exercise and EVH and, when sustained, is usually associated with release of inflammatory mediators of broncho constriction Another surrogate, mannitol dry powder, given by nhalation in progressively increasing doses, is used to mimic the dehydrating stimulus of exercise hyperpnoea A positive mannitol test is a 15% fall in FEV 1 at <635 mg and reveals potential for EIB. Mannitol has a high specificity for identifying a clinical diagnosis of asthma Once a diagnosis of EIB is established, the athlete needs to know how to avoid EIB. Being treated daily with an nhaled corticosteroid to reduce airway inflammation, inhaling a β 2 agonist or a cromone immediately before exercise, or taking a leukotriene antagonist severa hours before exercise, all inhibit or prevent EIB. Other strategies include warming up prior to exercise and reducing respiratory water and heat loss by using face masks or nasal breathing. Source

Kohler M.J.,University of South Australia | Kohler M.J.,University of Adelaide | Kennedy J.D.,University of Adelaide | Martin A.J.,Respiratory and Sleep Medicine | Lushington K.,University of South Australia
Sleep and Breathing

Purpose: Problematic behavior is widely reported in children with sleep-disordered breathing (SDB). Daytime behavior is an important component in the evaluation of clinical history in SDB; however, there is a reliance on parental report alone, and it is unclear whether reports by teachers will aid diagnosis. Methods: We assessed sleep and behavior reported by both parents and teachers in 19 children with SDB and 27 non-snoring controls. All children were screened for prior diagnoses of other medical and/or behavior and learning disorders and underwent polysomnography and both parental and teacher assessment of behavior. Results: Both parents and teachers report greater problematic behavior in SDB children, predominantly of an internalizing nature. Despite this consistency and moderate correlation between informants, the agreement between parent and teacher reports of individual child behavior was poor when assessed using Bland-Altman plots. Conclusions: Clinicians should be mindful that the behavioral history of a child being evaluated for SDB may vary depending on whether parent or teacher report is being discussed as this may influence clinical decision making. © 2012 Springer-Verlag. Source

Chawla R.,Sleep | Jain A.,Respiratory and Sleep Medicine | Jibhkate B.,Sleep
Indian Journal of Critical Care Medicine

Aim: To study the clinical characteristics and outcome of admitted patients of H1N1 (hemagglutinin-H neuraminidase-N) influenza in a tertiary level hospital, from Oct 2009 to Dec 2010. Materials and Methods: A retrospective analysis of 77 confirmed patients admitted in this unit with H1N1 infection. Results: Of the 77 patients studied, 33 (42.8%) were female. Mean age was 40.88 ± 13.45 years, majority (70.13%) being less than 50 years. Thirty eight (49.3%) patients had at least one co-morbidity, diabetes mellitus being the most common (n = 15, 19.5%). The most common presenting symptom was fever in 75 (97.4%) patients, cough in 67 (87%) and dyspnoea in 59 (76.6%) patients. At admission, mean PaO2/FiO2 ratio was 213.16 ± 132.75 mmHg (n = 60) while mean PaCO 2 was 40.14 ± 14.86 mmHg. One or more organ failure was present in 45 (58.4%) patients. Nineteen (24.60%) patients required invasive mechanical ventilation. Circulatory failure was observed in 10 (13%) patients while 2 patients required hemodialysis. Overall, 13% mortality (n = 10) was observed. PaCO 2 level at admission (OR 1.093; 95% confidence interval: 1.002-1.193; P = 0.044) and number of organ failure (OR 8.089; 95% confidence interval: 1.133-57.778; P = 0.037) were identified as independent risk-factors for mortality. Conclusion: Increased duration of dyspnoea prior to admission, pneumonia, low PaO 2/FiO 2 ratio at admission and 24 hours later, higher PaCO 2 values on admission, higher O 2 requirement, number of organ failures and use of corticosteroids and delay in specialized treatment were associated with a poorer outcome. Source

De Lauretis A.,Carlo Poma Hospital | De Lauretis A.,Catholic University of the Sacred Heart | Sestini P.,University of Siena | Pantelidis P.,Imperial College London | And 13 more authors.
Journal of Rheumatology

Objective. Biomarkers of progression of interstitial lung disease (ILD) are needed to allow early therapeutic intervention in patients with scleroderma-associated disease (SSc-ILD). Methods. A panel of 8 serum cytokines [interleukin 6 (IL-6), IL-8, IL-10, CCL2, CXCL10, vascular endothelial growth factor, fibroblast growth factor 2, and CX3CL1] was assessed by Luminex bead technology in exploratory cohorts of 74 patients with SSc and 58 patients with idiopathic pulmonary fibrosis (IPF). Mortality and significant lung function decline [forced vital capacity (FVC) ≥ 10%; DLCO ≥ 15%] from date of serum collection were evaluated by proportional hazards analysis. Based on these findings, the prognostic value of serum IL-6, evaluated by ELISA, was assessed in a larger test cohort of 212 patients with SSc-ILD. Results. In the exploratory cohort, only serum IL-6 was an independent predictor of DLCO decline in both IPF and SSc-ILD. The IL-6 threshold level most predictive of DLCO decline within a year was 7.67 pg/ml. In the larger test cohort, serum IL-6 > 7.67 pg/ml was predictive of decline in FVC (HR 2.58 ± 0.98, p = 0.01) and in DLCO (HR 3.2 ± 1.7, p = 0.02) within the first year, and predictive of death within the first 30 months (HR 2.69 ± 0.96, p = 0.005). When stratified according to severity (FVC < 70%), serum IL-6 > 7.67 pg/ml was predictive of functional decline or death within the first year in patients with milder disease (OR 3.1, 95% CI 1.4-7.2, p = 0.007), but not in those with severe ILD. Conclusion. In SSc-ILD, serum IL-6 levels appear to be predictive of early disease progression in patients with mild ILD, and could be used to target treatment in this group, if confirmed by prospective studies. The Journal of Rheumatology Copyright © 2013. All rights reserved. Source

Auld B.,Materials Childrens Hospital | Urquhart D.,Respiratory and Sleep Medicine | Walsh M.,Materials Childrens Hospital | Nourse C.,Materials Childrens Hospital | And 2 more authors.

Deficiencies of the interferon γ (IFN-γ) pathway have become a wellrecognized cause of nontuberculous mycobacterial infection. We report here a case of autosomal dominant IFN-γ receptor 1 (IFN-γ-R1) deficiency presenting at the unusually young age of 16 months with a severe clinical course. Mycobacterium avium complex was cultured from bronchial washings of a child who presented with primary endobronchial disease after a 4-month history of rhinorrhea, wheeze, and acute lobar consolidation. A maternal history of multifocal Mycobacterium kansasii osteomyelitis and cutaneous M avium complex led to genetic confirmation of IFN-γ-R1 818del4 deletion (a 4 base pair deletion at nucleotide position 818) in both family members. This case demonstrates the link between mycobacterial disease and IFN-γ pathway deficiency, the diagnosis of which facilitates more accurate therapy and genetic counseling. The case also raises questions about the reported distinct presentation, treatment, and prognosis of autosomal dominant and recessive IFN-γ-R1 phenotypes. Copyright © 2011 by the American Academy of Pediatrics. Source

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