Uruga H.,Respiratory Center
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society | Year: 2010
A 64-year-old woman was admitted to our hospital because of cough, bloody sputum and chest pain in January 2007. Chest computed tomography (CT) on admission revealed hyperattenuated mucoid impaction and consolidation in the right S3b. She was given a diagnosis of allergic bronchopulmonary mycosis caused by Schizophyllum commune. Treatment with 200 mg/day itraconazole and 15 mg/day oral prednisolone was begun, and her symptoms and consolidation resolved. In December 2007, consolidation in the left lower lobe appeared after itraconazole was stopped and replaced with oral prednisolone with inhaled fluticasone propionate. She again received 200 mg/day itraconazole and 15 mg/day oral prednisolone, resulting in a reduction in her consolidation. In May 2008, itraconazole was stopped and oral prednisolone was changed to inhaled salmeterol fluticasone propionate. In November 2008, her symptoms appeared again, and chest CT demonstrated hyperattenuated mucoid impaction and consolidation in the right S8. A transbronchial biopsy revealed granulomatosis, Charcot-Leyden crystals, and mucus infiltrated by eosinophils and fungi. Schizophyllum commune was isolated from her bronchial lavage fluid. A recurrence of allergic bronchopulmonary mycosis was diagnosed. Retreatment with itraconazole and oral prednisolone resulted in improvement of her symptoms and chest radiographic findings. To the best of our knowledge this is the first reported case of allergic bronchopulmonary mycosis caused by Schizophyllum commune presenting with hyperattenuated mucoid impaction.
Suresh Babu K.,Respiratory Center |
Kastelik J.,Castle Hill Hospital |
Morjaria J.B.,Castle Hill Hospital
Respiratory Medicine | Year: 2013
Antibiotics are commonly used in the management of respiratory disorders such as cystic fibrosis (CF), non-CF bronchiectasis, asthma and COPD. In those conditions long-term antibiotics can be delivered as nebulised aerosols or administered orally. In CF, nebulised colomycin or tobramycin improve lung function, reduce number of exacerbations and improve quality of life (QoL). Oral antibiotics, such as macrolides, have acquired wide use not only as anti-microbial agents but also due to their anti-inflammatory and pro-kinetic properties. In CF, macrolides such as azithromycin have been shown to improve the lung function and reduce frequency of infective exacerbations. Similarly macrolides have been shown to have some benefits in COPD including reduction in a number of exacerbations. In asthma, macrolides have been reported to improve some subjective parameters, bronchial hyperresponsiveness and airway inflammation; however have no benefits on lung function or overall asthma control. Macrolides have also been used with beneficial effects in less common disorders such as diffuse panbronchiolitis or post-transplant bronchiolitis obliterans syndrome. In this review we describe our current knowledge the use of long-term antibiotics in conditions such as CF, non-CF bronchiectasis, asthma and COPD together with up-to-date clinical and scientific evidence to support our understanding of the use of antibiotics in those conditions. © 2013 Elsevier Ltd. All rights reserved.
Baena-Cagnani C.E.,Catholic University of Cordoba |
Teijeiro A.,Catholic University of Cordoba |
Teijeiro A.,Respiratory Center |
Canonica G.W.,University of Genoa
Current Opinion in Allergy and Clinical Immunology | Year: 2015
Purpose of review Allergic asthma, which is the most frequent asthma phenotype, is mainly a chronic inflammatory disease characterized by elevated serum IgE levels and specific-IgE against common allergens. A significant group of asthmatic children have uncontrolled moderate/severe symptoms despite the use of medium/high doses of inhaled corticosteroids (ICS) in combination with another controller. Asthma guidelines suggest omalizumab as an add-on therapy in these children and recent evidence has shown the efficacy and safety of this mAb against IgE. Recent findings Asthma cannot be cured and current available treatments are unable to modify the natural course of the disease. Recent studies have shown positive effects of omalizumab in reducing airway inflammation and remodelling. Herein, a 4-year follow-up of a group of children with moderate/severe uncontrolled asthma taking part in a randomized double blind placebo control with omalizumab is shown. After discontinuation of anti-IgE, children were followed up for 4 years. During the first 3 years of follow-up, they were completely free of asthma symptoms without any need of ICS or rescue medication. Summary The new evidence published and the clinical observation described herein generate the hypothesis that treatment with omalizumab could potentially modify the natural course of asthma. However, further studies are needed. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Kohno T.,Toranomon Hospital |
Fujimori S.,Toranomon Hospital |
Kishi K.,Respiratory Center |
Fujii T.,Toranomon Hospital
Annals of Thoracic Surgery | Year: 2010
Background: Popularized computed tomography physical check up results in an increasing number of patients with ground glass opacity (GCO) lesions of which management has not been established yet. Methods: From January 2004 to December 2008, 738 patients underwent pulmonary resection for primary lung cancer, and 96 (13.0%) with resected GGO lesions were included in this study. Pure GGO lesions sized less than 10 mm are monitored until they grow bigger or develop a core. Three-port video-assisted thoracic lobectomy with systematic lymph node dissection is indicated when the lesion diameter exceeds 15 mm or is invasive, and segmentectomy is indicated when the tumor diameter is 10 to 15 mm. Wedge resection is indicated when the tumor is peripherally located. Results: There was no procedurally related mortality or morbidity. There were 9 papillary adenocarcinomas or invasive bronchioloalveolar carcinomas, 75 noninvasive bronchioloalveolar cell carcinomas, 7 atypical adenomatous hyperplasias, and 5 organizing pneumonias. No local recurrence was observed. Conclusions: Several pathologies are included in GGO lesions, and the video-assisted thoracic approach seems to be one of the best options in their management. © 2010 The Society of Thoracic Surgeons.
Arnold E.,University of Southampton |
Arnold E.,The Turner Center |
Bruton A.,University of Southampton |
Donovan-Hall M.,University of Southampton |
And 3 more authors.
BMC Pulmonary Medicine | Year: 2011
Background: Patients with COPD on long term oxygen therapy frequently do not adhere to their prescription, and they frequently do not use their ambulatory oxygen systems as intended. Reasons for this lack of adherence are not known. The aim of this study was to obtain in-depth information about perceptions and use of prescribed ambulatory oxygen systems from patients with COPD to inform ambulatory oxygen design, prescription and management.Methods: A qualitative design was used, involving semi-structured face-to-face interviews informed by a grounded theory approach. Twenty-seven UK community-dwelling COPD patients using NHS prescribed ambulatory systems were recruited. Ambulatory oxygen systems comprised cylinders weighing 3.4 kg, a shoulder bag and nasal cannulae.Results: Participants reported that they: received no instruction on how to use ambulatory oxygen; were uncertain of the benefits; were afraid the system would run out while they were using it (due to lack of confidence in the cylinder gauge); were embarrassed at being seen with the system in public; and were unable to carry the system because of the cylinder weight. The essential role of carers was also highlighted, as participants with no immediate carers did not use ambulatory oxygen outside the house.Conclusions: These participants highlighted previously unreported problems that prevented them from using ambulatory oxygen as prescribed. Our novel findings point to: concerns with the lack of specific information provision; the perceived unreliability of the oxygen system; important carer issues surrounding managing and using ambulatory oxygen equipment. All of these issues, as well as previously reported problems with system weight and patient embarrassment, should be addressed to improve adherence to ambulatory oxygen prescription and enhance the physical and social benefits of maintaining mobility in this patient group. Increased user involvement in both system development and service provision planning, could have avoided many of the difficulties highlighted by this study. © 2011 Arnold et al; licensee BioMed Central Ltd.