Respiratory Tract Diseases Commons^™

The Affordable Care Act, Medical Homes, And Childhood Asthma: A Key Opportunity For Progress, Meagan Lyon, Anne Rossier Markus, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

The medical homes provisions of the Affordable Care Act offer a major opportunity to advance high quality, cost-efficient health care for children with asthma. This policy brief examines evolving national medical homes policy in a childhood asthma context. Following a brief background that examines childhood asthma and explores the origins and evolution of medical homes policy (a concept developed with children in mind), the brief then describes how the Affordable Care Act can advance the implementation of medical homes policies to improve health outcomes for children with asthma.

The Efficacy Of Spirometry As A Screening Tool In Detection Of Air Flow Obstruction, Nabeel Manzar, A. Suleman Haque, Bushra Manzar, Muhammad Irfan

Section of Pulmonary & Critical Care

Background/Objectives: In developing countries, spirometry has not been considered a part of routine medical check-up. The purpose of the study was to establish the usefulness of spirometry as a primary screening tool in detecting air flow obstruction (AFO) during routine medical check-up (RMC). Methods: This was a hospital based, retrospective, non-randomized case series study of 3696 participants, who presented to hospital for routine medical check-up. All subjects were assisted at the Pulmonary Medicine Department, from January 2003 till December 2008 who, having met other inclusion criteria, underwent spirometry. Data were analyzed using proportion, group means, standard deviations and …

Single Lung Ventilation In A Young Child For Repair Of Coarctation Of Aorta, Mohammad Hamid, Mansoor Ahmed Khan, Muneer Amanullah

Department of Anaesthesia

Single lung ventilation in small children is extremely challenging. In this case, a paediatric bronchial blocker was successfully inserted in a 19-month-old child to provide single lung ventilation using a modified insertion technique. It provided excellent working conditions during thoracotomy and our method of insertion may help in reducing the cost.

Lung Carcinoma: Its Profile And Changing Trends, Saad Siddiqui, Mohammed Usman Ali, Mahrukh Ayesha Ali, Noreen Shah, Shagufta Nasreen

Section of Pulmonary & Critical Care

BACKGROUND: Lung Carcinoma is the leading causes of morbidity and mortality worldwide with an incidence of 1.3 million cases per year. This study was undertaken to determine prevalence of various histological types of lung carcinoma and to analyse their changing trends with time.

METHODS: This is a retrospective analytical study. A total of 330 cases of lung carcinoma were analysed from 2003 to 2008. Cases from Khyber Pakhtunkhwa and Federally Administered Tribal Area (FATA) were included in this study. Furthermore, only cases of lung carcinoma were considered while other malignancies were excluded.

RESULTS: Squamous Cell carcinoma was found in 42.7% …

Osteopontin And Cadherin 11 Are Novel Mediators And Drug Targets For Chronic Lung Diseases, Daniel J. Schneider

Dissertations and Theses (Open Access)

Chronic lung diseases (CLDs) are a considerable source of morbidity and mortality and are thought to arise from dysregulation of normal wound healing processes. An aggressive, feature of many CLDs is pulmonary fibrosis (PF) and is characterized by excess deposition of extracellular matrix (ECM) proteins from myofibroblasts in airways. However, factors regulating myofibroblast biology are incompletely understood. Proteins in the cadherin family contribute epithelial to mesenchymal transition (EMT), a suggested source of myofibroblasts. Cadherin 11 (CDH11) contributes to developmental and pathologic processes that parallel those seen in PF and EMT. Utilizing Cdh11 knockout (Cdh11 -/-) mice, the goal of this …

Drug Resistance Pattern In Multidrug Resistance Pulmonary Tuberculosis Patients, Nisar Ahmed Rao, Muhammad Irfan, Mir Mir Soomro, Zeeshan Mehfooz

Section of Pulmonary & Critical Care

Objective: To evaluate accuracy of modified Kenneth Jones scoring criteria (MKJSC) as a screening tool to diagnose tuberculous meningitis in children. Study Design: Cross-sectional study. Place and Duration of Study: Paediatric Medicine, Unit-I, Bahawal Victoria Hospital, Bahawalpur, from May 2006 to March 2007. Methodology: A total of 100 children admitted through emergency in Paediatric Medicine, Unit-I, were included who were having fever and features suggestive of central nervous system (CNS) infection. Lumbar puncture was done in all patients after written consent. Findings of lumbar puncture were taken as gold standard for the diagnosis of TBM. MKJSC was applied on each …

The Role Of The Ras Superfamily Small G-Proteins In The Proinflammatory Environment Of Rhinovirus-Exposed Monocytic-Lineage Cells, Michael Schreiber

Lawrence University Honors Projects

Rhinoviral infections are a major cause of asthma exacerbations, and though productive rhinovirus infection occurs predominantly in the bronchial epithelial cells of the upper airway, monocytic-lineage cells are implicated in establishing the inflammatory microenvironment observed during rhinoviral asthma exacerbation. It has remained unclear whether small G-protein activation plays a role in establishing this inflammatory microenvironment. The small molecular- weight G-proteins are known to be activated in a variety of cell types upon exposure to a range of viruses. However, it is unclear if small G-protein activation during viral exposure is a byproduct of receptor attachment, is important for viral replication, …

Changing Po2licy: The Elements For Improving Childhood Asthma Outcomes, Anne Rossier Markus, Meagan Lyon, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Childhood asthma is a serious and chronic health issue that affects one in seven U.S. children and their families, compromising their health and quality of life and placing a heavy financial burden on families as well as an enormous strain on the health care system. Treating, managing, and ultimately preventing and reducing the burden of asthma represents a critical test of the ability of the U.S. health system – health insurers, clinical care providers, and public health agencies – to work together. Our investigation found that, as a country, we already know enough to act and improve life for the …

Sputum Neutrophils As A Biomarker In Copd: Findings From The Eclipse Study, Dave Singh, Lisa Edwards, Ruth Tal-Singer, Stephen I. Rennard

Journal Articles: Pulmonary & Critical Care Med

INTRODUCTION: The percentage of neutrophils in sputum are increased in COPD patients, and may therefore be a biomarker of airway inflammation. We studied the relationships between sputum neutrophils and FEV1, health status, exacerbation rates, systemic inflammation and emphysema, and long term variability at 1 year.

METHODS: Sputum samples were obtained from 488 COPD patients within the ECLIPSE cohort. 359 samples were obtained at baseline, and 297 after 1 year. 168 subjects provided samples at both visits. Serum interleukin-6 (IL-6), IL-8, surfactant protein D and C-reactive protein levels were measured by immunoassays. Low-dose CT scans evaluated emphysema.

RESULTS: Sputum neutrophil % …

Variables Predictive Of Outcome In Patients With Acute Hypercapneic Respiratory Failure Treated With Noninvasive Ventilatio, Nawal Salahuddin, Muhammad Irfan, Shereen Khan, Muhammad Naeem, Ahmad Suleman Haque, Shahid Javed Husain, Nisar Ahmed Rao, Ali Bin Sarwar Zubairi, Javaid Khan

Section of Pulmonary & Critical Care

OBJECTIVE: To assess results with NIV in acute hypercapneic respiratory failure and to identify outcome predictors.

METHODS: This was a retrospective observational study on consecutive patients presenting with acute type II respiratory failure and meeting criteria for NIV use over a 5 year period. Patients presenting with haemodynamic instability, inability to protect their airway, malignant arrhythmias and recent oesophageal surgery were excluded. Univariate and Multivariate regression analysis was used to determine the impact on survival. A p value of < 0.05 was considered statistically significant. Software used was SPSS 14.

RESULTS: Total numbers of patients included were 119; 52.9% were males. Mean age was 63.4 +/- 11.9 years. Overall Survival to …

Characterisation Of Copd Heterogeneity In The Eclipse Cohort, Alvar Agusti, Peter M.A. Calverley, Bartolome Celli, Harvey O. Coxson, Lisa D. Edwards, David A. Lomas, William Macnee, Bruce E. Miller, Steve I. Rennard, Edwin K. Silverman, Ruth Tal-Singer, Emiel Wouters, Julie C. Yates, Jørgen Vestbo, The Evaluation Of Copd Longitudinally To Identify Predictive Surrogate Endpoints (Eclipse) Investigators

Journal Articles: Pulmonary & Critical Care Med

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a complex condition with pulmonary and extra-pulmonary manifestations. This study describes the heterogeneity of COPD in a large and well characterised and controlled COPD cohort (ECLIPSE).

METHODS: We studied 2164 clinically stable COPD patients, 337 smokers with normal lung function and 245 never smokers. In these individuals, we measured clinical parameters, nutritional status, spirometry, exercise tolerance, and amount of emphysema by computed tomography.

RESULTS: COPD patients were slightly older than controls and had more pack years of smoking than smokers with normal lung function. Co-morbidities were more prevalent in COPD patients than in …