Pulmonology Commons^™

Allergic Bronchopulmonary Aspergillosis Misdiagnosed As Smear Negative Pulmonary Tuberculosis; A Retrospective Study From Pakistan, Nousheen Iqbal, Muhammad Dawood Amir Sheikh, Kauser Jabeen, Safia Awan, Muhammad Irfan

Section of Pulmonary & Critical Care

Background: Undiagnosed allergic bronchopulmonary aspergillosis (ABPA) can lead to chronic persistent symptoms. In country like Pakistan where tuberculosis (TB) is endemic, a significant proportion of ABPA patients are misdiagnosed as smear negative TB before reaching a diagnosis of ABPA due to chronicity of symptoms.This lead to empiric use of ATT(Anti-tuberculous therapy) and delay in primary diagnosis. The aim of the study is to determine such proportion of ABPA patients.|
Material and methods: This retrospective study was conducted at the outpatient pulmonology clinic of a tertiary care hospital in Karachi, Pakistan from January 2017 to December 2018. Xpert MTB/Rif, TB smear …

Real-World Assessment Of Asthma Specialist Visits Among U.S. Patients With Severe Asthma., Jessica F Most, Christopher S Ambrose, Yen Chung, James L Kreindler, Aimee Near, Stephen Brunton, Yao Cao, Huan Huang, Xiaohui Zhao

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

BACKGROUND: U.S. guidelines recommend that patients with severe asthma be referred to specialists (allergists/immunologists or pulmonologists) for systematic assessment or comanagement; however, contemporary, real-world data on the frequency and impact of specialist care among U.S. severe asthma patients are lacking.

OBJECTIVES: To quantify the frequency of asthma specialist visits among U.S. patients with severe asthma, identify patient demographic and clinical characteristics associated with specialist visits and describe health outcomes following specialist care.

METHODS: Severe asthma patients aged 6 years or older were identified between January 1, 2015, and December 31, 2017, in the IQVIA PharMetrics® Plus database of commercially insured …

Improving The Use Of Asthma Action Plans, Pooja Pandit, Md, Aaron B. Kaye, Md, Hassan Shahid, Md, Colin Peters, Do, Jessica Most, Md

Health Equity and Quality Improvement (HEQI) Summit

Objectives

• Identify the percentage of asthmatics in Friday fellows’ clinic with an AAP in place.
• Determine if clinician education can increase the number of AAP created for patients.

Effect Of Intrauterine Smoke Exposure On Microrna-15a Expression In Human Lung Development And Subsequent Asthma Risk., Sunita Sharma, Alvin T. Kho, Divya Chhabra, Kathleen Haley, Carrie A. Vyhlidal, R Gaedigk, J Steven Leeder, Kelan G. Tantisira, Benjamin Raby, Scott T. Weiss

Manuscripts, Articles, Book Chapters and Other Papers

Background: In utero smoke (IUS) exposure is associated with asthma susceptibility.

Objective: We sought to test the hypothesis that changes in miRNA expression by IUS exposure during human lung development is associated with asthma susceptibility.

Methods: Gene expression was profiled from 53 IUS unexposed and 51 IUS exposed human fetal lung tissues. We tested for the differential expression of miRNAs across post-conception age and by IUS using linear models with covariate adjustment. We tested the IUS-associated miRNAs for association with their gene expression targets using pair-wise inverse correlation. Using our mouse model, we investigated the persistence of the IUS-associated miRNA …

Exploring The Effectiveness Of Asthma Action Plans In Long-Term Asthma Management, Pankhuri Jha, Jessica Most, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

• Determine the efficacy of AAP in helping patients feel more confident in their self-management
• Improve asthma control by at least 10% after receiving an Asthma Action Plan

Galcanezumab-Induced Anaphylaxis: A Case Report, Erick Perez Sifontes, Sonja Knittel-Hliddal, Zhao Han, Rahimullah Asad, Aya Marachi, Uma Iyer

Pulmonary Disease

Introduction: Case Report: Galcanezumab is a monoclonal antibody recently approved by the FDA for migraine prevention. Common side effects include injection site reactions, nasopharyngitis, and nausea. However, there have been no reported cases of anaphylaxis.

Description: We describe the first case of galcanezumab-induced anaphylaxis in a 47-year-old female with history of asthma and a prior episode of topiramate-induced anaphylaxis requiring intubation. The patient presented to the emergency department (ED) complaining of sudden onset shortness of breath, generalized pruritus, flushing, throat and mouth swelling 20 minutes after self- administration of two 120 mg doses of galcanezumab IM. Prior to ED presentation, …

Improving The Inhaler, Kabir Malkani, Jesse Evensky, Bradley Freid, Alex Reibstein, Gregory C. Kane, Md

Phase 1

Background: It is estimated that about 1 in 10 Americans use inhalers to deliver inhaled drugs for respiratory disease such as COPD and asthma. Some studies have shown that up to 84% of people use their inhaler incorrectly, which can cause long term problems and acute flareups. Therefore, improving the inhaler design to allow for ease of use was the main focus of our project.

Methods: We had a discussion with a pulmonary critical care attending who provided information on proper patient inhaler use and common user errors. He also gave us a sample of different inhalers on the market …

Improving The Inhaler, Alex Reibstein, Jesse Evensky, Bradley Freid, Kabir Malkani, Gregory C. Kane, Md

Phase 1

Background: Inhalers used to dispense various pharmacological agents play an important role in the care of patients with pulmonary disease. These pharmacological agents can be very effective, however, many patients that use inhalers often deliver these drugs incorrectly or in a sub-optimal manner. Our project aims to improve the design of the inhaler in order to increase the effectiveness of drug delivery and also ease of patient use.

Methods: We interviewed a critical care pulmonologist regarding patient inhaler use and compliance. This physician offered information about proper inhaler use and described common errors that patients encounter when attempting to dispense …

Improvements On The Inhaler, Jesse Evensky, Bradley Freid, Kabir Malkani, Alex Reibstein, Gregory C. Kane, Md

Phase 1

Background: Inhalers are a commonplace in American health care and deliver crucial drugs to patients with COPD and asthma. Inhaler use has been shown to be unsatisfactory among patients resulting in ineffective medication delivery. The goal of this project was to improve the inhaler design for increased effectiveness and ease of use.

Methods: Our team first interviewed a Pulmonologist regarding patient inhaler use. Dr. Harry Kane demonstrated the proper use of an inhaler as well and described errors in inhaler use are due to patient technique. A variety of inhalers currently available were examined and were compared for ease of …

Improving The Inhaler, Bradley Freid, Jesse Evensky, Kabir Malkani, Alex Reibstein, Gregory C. Kane, Md

Phase 1

Background: Inhaled drugs play a critical role in caring for patients with respiratory disease such as COPD and asthma. It is understood that many of the patients that use inhalers to deliver these drugs to their lungs use them entirely improperly or in a sub-optimal manner. Improving the inhaler design for increased effectiveness and ease of use was the focus of this project.

Methods: A pulmonary critical care attending was interviewed regarding patient inhaler use. The attending provided information about proper inhaler use and also described patient errors in using the inhaler that were observed. Inhalers that are currently in …

The Role Of Diagnostic Bronchoscopy In Refractory Asthma Management, Christopher Mcgrath, Md, Tuhina Raman, Md, Jessica Most, Md

Division of Pulmonary, Allergy, and Critical Care Medicine Posters

Refractory asthma is an uncommon entity, manifesting in less than five percent of asthmatics and characterized by high medication requirements, persistent symptoms, frequent exacerbations, and significant airflow obstruction despite standard medical therapy.[1] Bronchoscopy may be an effective tool for identifying refractory asthma phenotypes.[3] The objective of this case series is to demonstrate the use of bronchoscopy to personalize treatment among a population of refractory asthmatics.

The Effects Of Implementing A Smartphone Application To Improve Asthma Self-Management In Adults, Lindsay J. Humpfer

Evidence-Based Practice Project Reports

Asthma is one of the most common chronic diseases, affecting 20.4 million adults in the United States (CDC, 2018). While asthma can generally be controlled, patients having an exacerbation may experience missed days of work and school, limitations in daily activities, decreased enjoyment of life, and decreased productivity at home, work, and school (MarcanoBelisario et al., 2013). Therefore, the purpose of this project was to improve patients’ overall asthma control and asthma-related quality of life by encouraging self-management through patient education and the implementation of a mobile smartphone application. A total of 26 adult primary care patients with asthma participated …

Epidemiology Of Asthma And Associated Factors In An Urban Pakistani Population: Adult Asthma Study-Karachi, Shama Razzaq, Asaad Ahmed Nafees, Unaib Rabbani, Muhammad Irfan, Shahla Naeem, Muhammad Arslan Khan, Zafar Fatmi, Peter Burney

Community Health Sciences

Background: This study was conducted in order to determine the prevalence of asthma and associated risk factors in the adult population of Karachi, Pakistan.
Methods: This multi-stage, cross-sectional survey was conducted from May 2014-August 2015; comprising 1629 adults in 75 randomly selected clusters in Karachi, Pakistan. Definitions included: 'self-reported asthma', 'reversibility in FEV₁^' and 'respiratory symptoms and reversibility in FEV₁'.
Results: Prevalence of asthma was 1.8% (self-reported) (95% CI: 1.0-2.6), 11.3% (reversibility in FEV₁) (95% CI: 9.4-13.3) and 6.6% (symptoms and reversibility in FEV₁) (95% CI: 5.1-8.1). Asthmatics were more likely to …

Use Of Venovenous Extracorporeal Membranous Oxygenation Following Iatrogenic Tracheal Rupture, Rajiv Kabadi, Md

The Medicine Forum

INTRODUCTION

Iatrogenic tracheal rupture is a rare complication of endotracheal intubation and has a high risk of morbidity and mortality. Risk factors include female gender, short stature (height less than 160-cm), difficult airway anatomy, underlying connective tissue disorder, chronic obstructive pulmonary disease, use of a rigid stylet, inadequate intubation tube size, cuff over-inflation, emergent intubation and intubation performed by non-anesthesiologists. 1 Early recognition is important and diagnosis requires bronchoscopic confirmation.2,3 We describe a case where emergent venovenous extra-corporeal membrane oxygenation (VV-ECMO) was utilized in the management of tracheal rupture.

KEY POINTS

• Tracheal rupture is an uncommon but severe complication of …

The Western Diet: A Smoking Gun For Chronic Obstructive Pulmonary Disease And Asthma?, Conor Kerley

Other resources

No abstract provided.

Sustained Sensitizing Effects Of Tumor Necrosis Factor Alpha On Sensory Nerves In Lung And Airways, Ruei-Lung Lin, Qihai Gu, Mehdi Khosravi, Lu-Yuan Lee

Physiology Faculty Publications

Tumor necrosis factor alpha (TNFα) plays a significant role in the pathogenesis of airway inflammatory diseases. Inhalation of aerosolized TNFα induced airway hyperresponsiveness accompanied by airway inflammation in healthy human subjects, but the underlying mechanism is not fully understood. We recently reported a series of studies aimed to investigate if TNFα elevates the sensitivity of vagal bronchopulmonary sensory nerves in a mouse model; these studies are summarized in this mini-review. Our results showed that intratracheal instillation of TNFα induced pronounced airway inflammation 24 hours later, as illustrated by infiltration of eosinophils and neutrophils and the release of inflammatory mediators and …

Knowledge About Asthma: A Cross-Sectional Survey In 4 Major Hospitals Of Karachi, Pakistan, Omar Irfan, Babar Irfan, Zain Ahmad Khan, Maha Tahir, Ali Bin Sarwar Zubairi, Javaid Ahmad Khan

Section of Pulmonary & Critical Care

Objective: To determine knowledge and misconceptions about asthma among the local population..Methods: This cross-sectional study was conducted at four tertiary care hospitals; Aga Khan University Hospital, Civil Hospital Karachi, Jinnah Postgraduate Medical Centre and Ojha Institute of Chest Diseases, Karachi, from October to November 2016, and comprised hospital attendants. The questionnaire used in the study comprised 26 questions answered with a true, false or not sure answer.SPSS 20 was used for data analysis.Results: There were 400 participants. The overall mean age was 41.2±14.2 years, and 214(53.5%) of the participants were males. Moreover, 75(19%) participants thought that asthma was a psychological …

Airway Secretory Micrornaome Changes During Rhinovirus Infection In Early Childhood, Maria J. Gutierrez, Jose L. Gomez, Geovanny F. Perez, Krishna Pancham, Stephanie Val, Dinesh K. Pillai, Mamta Giri, Sarah Ferrante, Robert Freishtat, Mary C. Rose, Diego Preciado, Gustavo Nino

Pediatrics Faculty Publications

Background Innate immune responses are fine-tuned by small noncoding RNA molecules termed microRNAs (miRs) that modify gene expression in response to the environment. During acute infections, miRs can be secreted in extracellular vesicles (EV) to facilitate cell-to-cell genetic communication. The purpose of this study was to characterize the baseline population of miRs secreted in EVs in the airways of young children (airway secretory microRNAome) and examine the changes during rhinovirus (RV) infection, the most common cause of asthma exacerbations and the most important early risk factor for the development of asthma beyond childhood.

Methods Nasal airway secretions were obtained from …

Allergen Immunotherapy For Allergic Asthma: Protocol For A Systematic Review., Sangeeta Dhami, Ulugbek Nurmatov, Ioana Agache, Susanne Lau, Antonella Muraro, Marek Jutel, Graham Roberts, Cezmi Akdis, Matteo Bonini, Moises Calderon, Thomas Casale, Ozlem Cavkaytar, Linda Cox, Pascal Demoly, Breda Flood, Eckard Hamelmann, Kenji Izuhara, Ömer Kalayci, Jörg Kleine-Tebbe, Antonio Nieto, Nikolaos Papadopoulos, Oliver Pfaar, Lanny Rosenwasser, Dermot Ryan, Carsten Schmidt-Weber, Stan Szefler, Ulrich Wahn, Roy-Gerth Van Wijk, Jamie Wilkinson, Aziz Sheikh

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: The European Academy of Allergy and Clinical Immunology (EAACI) is in the process of developing the EAACI Guidelines for Allergen Immunotherapy (AIT) for Allergic Asthma. We seek to critically assess the effectiveness, cost-effectiveness and safety of AIT in the management of allergic asthma.

METHODS: We will undertake a systematic review, which will involve searching international biomedical databases for published, in progress and unpublished evidence. Studies will be independently screened against pre-defined eligibility criteria and critically appraised using established instruments. Data will be descriptively and, if possible and appropriate, quantitatively synthesised.

DISCUSSION: The findings from this review will be used …

Bronchial Thermoplasty, Javier Diaz-Mendoza, Chong Bai, Hai-Dong Huang, Michael J. Simoff

Internal Medicine Faculty Publications

No abstract provided.

A Study Of Emergency Room Utilization Related To Poorly Controlled Asthma In Pediatrics, Leistey T. Wortman

Nursing Theses and Capstone Projects

Asthma is a disease of the respiratory system, which causes swelling and narrowing of the airways. Asthma is commonly seen in children. It is the leading cause of hospital stays and school absences. Hospitalization accounts for the single largest portion of the direct health care costs for asthma, estimated at nearly $18 billion a year (Everage, et al, 2010). Children with asthma may be able to breathe normally most of the time but when they encounter a substance that can cause problems (a "trigger"); an asthma attack (exacerbation) can occur (PubMed Health, 2011). The purpose of this study is to …

Differentiating Asthma From Its Mimics, Zeeshan Waheed, Muhammad Irfan, Mohammad Salih, Ali Bin Sarwar Zubairi

Section of Pulmonary & Critical Care

All that wheezes is not asthma this adage accredited to Chevalier Jackson emphasizes the importance of differentiating asthma from its mimics, particularly if the patient is not responding to usual therapy. The above statement also warrants further diagnostic evaluation and management of non-asthma conditions that mimic asthma. We present here a case of a middle aged female who presented with severe bronchospasm, initially labeled as asthma but was resistant to usual anti-asthma therapy. After further workup she was eventually diagnosed to have esophageal achalasia.

Exercise-Induced Asthma: Critical Analysis Of The Protective Role Of Montelukast., Terrence W. Carver

Manuscripts, Articles, Book Chapters and Other Papers

Exercise-induced asthma/exercise-induced bronchospasm (EIA/EIB) is a prevalent and clinically important disease affecting young children through older adulthood. These terms are often used interchangeably and the differences are not clearly defined in the literature. The pathogenesis of EIA/EIB may be different in those with persistent asthma compared to those with exercise-induced symptoms only. The natural history of EIA is unclear and may be different for elite athletes. Leukotriene biology has helped the understanding of EIB. The type and intensity of exercise are important factors for EIB. Exercise participation is necessary for proper development and control of EIA is recommended. Symptoms of …

Allergic Bronchopulmonary Aspergillosis: An Unusual Complication Of Bronchial Asthma, S F. Hussain, J A. Khan, M A. Khan

Section of Pulmonary & Critical Care

Asthma is a common medical problem in Pakistan. Allergic Bronchopulmonary Aspergillosis (ABPA), an immune mediated disease, is an unusual complication of bronchial asthma which can result in bronchiectasis, pulmonary fibrosis, respiratory failure and death. Early diagnosis is important so that with proper therapy permanent lung damage can be prevented. First described in 19521 , ABPA was thought to be a rare disorder, but with increased awareness amongst the physicians and better diagnostic techniques, äases are being recognized more frequently. The clinical features of ABPA (cough, fever, hemoptysis and lung infiltrates) are usually mistaken for pulmonary tuberculosis (TB). We present three …

An Audit On Hospital Management Of Bronchial Asthma, J A. Khan, S Saghir, G Tabassum, S F. Husain

Section of Pulmonary & Critical Care

Medical audit is a new concept in developing countries like Pakistan. We carried out this retrospective study on bronchial asthma. The purpose was to see if care given to patient with asthma meets the accepted international standard or not. During this audit several deficiencies were found. Documentation in notes about signs indicating severity of asthma was very poor. Peak flow recording in the notes was also very deficient. There was no documentation in notes whether inhalers technique of the patients has been checked or not. This audit shows that care given to asthma patients is far from satisfactory and we …

Endobronchial Tuberculosis Simulating Bronchial Asthma, J A. Khan, N Islam, J Akhter, S F. Hussain

Section of Pulmonary & Critical Care

No abstract provided.