Advances in Evaluation and Treatment of Severe Asthma (Part Two).

Providers caring for patients with severe, therapy-resistant asthma have novel options for their treatment. Administration of additional inhaled corticosteroids at the time of increased symptoms, a strategy referred to as anti-inflammatory rescue or AIR, has been proved to be effective in reducing the frequency of exacerbations and improving asthma-related quality of life. Long-acting muscarinic antagonists can be used in combination with long-acting beta-agonist bronchodilators for additional bronchodilation.

Synthesis and Evaluation of Functionalized Aryl and Biaryl Isothiocyanates against Human MCF-7 Cells.

Organic isothiocyanates (ITCs) are a class of anticancer agents which naturally result from the enzymatic degradation of glucosinolates produced by Brassica vegetables. Previous studies have demonstrated that the structure of an ITC impacts its potency and mode(s) of anticancer properties, opening the way to preparation and evaluation of synthetic, non-natural ITC analogues. This study describes the preparation of a library of 79 non-natural ITC analogues intended to probe further structure-activity relationships for aryl ITCs and second-generation, functionalized biaryl ITC variants.

Musculoskeletal and pulmonary outcomes of sarcoidosis after initial presentation of osseous involvement.

Objective: We aimed to investigate the musculoskeletal and pulmonary outcomes of patients with osseous sarcoidosis.

Methods: We identified 24 patients with osseous sarcoidosis and at least one year of follow-up after diagnosis (baseline). We collected outcome data at 1-year follow-up and last follow-up.

Core Components for a Clinically Integrated mHealth App for Asthma Symptom Monitoring.

Background mHealth apps may be useful tools for supporting chronic disease management. Objective Our aim was to apply user-centered design principles to efficiently identify core components for an mHealth-based asthma symptom–monitoring intervention using patient-reported outcomes (PROs). Methods We iteratively combined principles of qualitative research, user-centered design, and “gamification” to understand patients' and providers' needs, develop and refine intervention components, develop prototypes, and create a usable mobile app to integrate with clinical workflows.

Osseous sarcoidosis: clinical characteristics, treatment, and outcomes--experience from a large, academic hospital.

Objective: Osseous sarcoidosis has been infrequently reported. We aimed to characterize the distribution of lesions, clinical presentation, treatment, and outcomes for osseous sarcoidosis.

Methods: Cases of osseous sarcoidosis were identified by directed inquiry to clinicians and electronic query.

Non-tuberculous mycobacterial pulmonary infection in the immunocompetent host.

Throughout much of the world, the incidence of non-tuberculous mycobacterial pulmonary infections in immunocompetent hosts is on the rise. These organisms are widespread in the natural environment; the explanation for what appears to be an increased susceptibility among human hosts is uncertain. Among more than 120 known species, the most common pathogenic isolate in the USA is Mycobacterium avium complex.

Difficult asthma: assessment and management, Part 1.

A minority of asthma patients have disease that proves difficult to control with usual medications and experience ongoing symptoms, poor quality of life, and limitations in activity and/or frequent asthma exacerbations. This group of patients accounts for much of the expense associated with asthma care and is the focus of national and international collaborative study groups. Distinguishing between "difficult-to-manage asthma" and truly "therapy-resistant asthma" is helpful and promotes a systematic consideration of contributory factors.

Asthma: in plain language.

The Community Asthma Program was designed to increase awareness of asthma among urban residents and to bring more people into available care. Educational sessions with patients indicated that many adults struggle with the complicated demands of managing a chronic disease. At the same time, however, a good deal of the written materials meant to provide information and assistance instead make inappropriate demands on the average adult reader.

Late onset asthma: epidemiology, diagnosis and treatment.

Asthma is common among older persons, affecting approximately 4 to 8% of those above the age of 65 years. Despite its prevalence, late onset asthma may be misdiagnosed and inadequately treated, with important negative consequences for the patient's health. The histopathology of late onset disease appears to be similar to that of asthma in general, with persistent airway inflammation a characteristic feature.

Systemic immunological changes induced by administration of grass pollen allergens via the oral mucosa during sublingual immunotherapy.

Twenty-four patients suffering from grass pollen allergy underwent sublingual immunotherapy (SLIT) with standardized grass pollen extract for 1 year. In order to investigate immunological changes induced by the administration of allergens via the oral mucosa, the SLIT-spit method was applied. The cumulative dose of approximately 80 microg of major allergen (grass group 5 allergen), was relatively low.

Medical and ventilatory management of status asthmaticus.

Despite improved understanding of the basic mechanisms underlying asthma, morbidity and mortality remain high, especially in the "inner cities." The treatment of choice in status asthmaticus includes high doses of inhaled beta 2-agonists, systemic corticosteroids, and supplemental oxygen. The roles of theophylline and anticholinergics remain controversial, although in general these agents appear to add little to the bronchodilator effect of inhaled beta-agonists in most patients.

A comparison of ipratropium and albuterol vs albuterol alone for the treatment of acute asthma.

To evaluate the role of inhaled ipratropium bromide in acute asthma, a double-blind study of 384 emergency department patients compared the effect of the combination of ipratropium and albuterol with that of albuterol alone. Patients were randomized to receive nebulizer treatments with either 2.5 mg of albuterol or 2.

Bronchodilator therapy in the management of acute asthma.

Bronchodilator management of acute severe asthma has evolved considerably in recent years. beta-adrenergic agonists have emerged as the single most potent class of bronchodilator available, and the inhalational route of administration has proven to be the most effective and least toxic method of delivery except among apneic or highly uncooperative patients. Other bronchodilators, including aminophylline, inhaled anticholinergics, and intravenous magnesium sulfate, are significantly less potent drugs for reversal of bronchoconstriction.

Expired nitric oxide levels during treatment of acute asthma.

Nitric oxide (NO) is known to be present in measurable quantities in the exhaled air of normal subjects and at higher concentrations in asthmatic subjects not treated with glucocorticoids. We confirmed these findings by analyzing the mean mixed expired NO concentrations of 43 stable asthmatics and 90 normal subjects; NO levels were higher in the asthmatic population (13.9 parts per billion [ppb] versus 6.

Bronchiectasis. A late feature of severe rheumatoid arthritis.

Bronchiectasis as a feature of rheumatoid arthritis is considered rare and, in most series, has preceded rheumatoid arthritis. We identified 23 patients with rheumatoid arthritis and bronchiectasis at the Brigham and Women's Hospital followed between 1984 and 1991, 18 of whom had arthritis preceding lung disease. The 18 patients with rheumatoid arthritis and subsequent bronchiectasis had a mean age of 63.

The impact of socioeconomic status on the intensity of ambulatory treatment and health outcomes after hospital discharge for adults with asthma.

Objectives: To examine whether differences in intensities of care by socioeconomic status and race result in worse health among adults with asthma post-hospital discharge.

Design: Patients were enrolled during hospitalization and recontacted three months after discharge.

Patients: Those aged 18-55 years, with a primary diagnosis of asthma (n = 97).

Recovery of leukotriene E4 from the urine of patients with airway obstruction.

The urinary excretion of leukotriene E4 (LTE4) was measured in subjects presenting for emergency treatment of airway obstruction. A total of 72 subjects presenting with airway obstruction performed peak flow determinations before and after three treatments with nebulized albuterol given at 20-min intervals. Of these subjects, 22 more than doubled their peak flow rates, while 19 failed to increase their peak flow rates more than 25% during the treatment period.