ABSTRACT
The aim of this study was to examine the daily practice patterns of Symbicort® Maintenance and Reliever Therapy (SMART) in Korean asthmatic patients and to analyze clinical signs related to overuse. This study used an observational, multicenter, noninterventional, prospective, uncontrolled design for examining asthmatic patients prescribed SMART to assess the frequency and pattern of Symbicort® usage as a maintenance and reliever medication. The characteristics of patients showing signs of overuse (frequency of inhalation: 8 or more times per day) were also analyzed. Among the 1,518 patients analyzed, 1,292 (85.1%) completed the trial. The number of mean inhalations per day was 2.14±1.15; the number of patients who had at least 1 as needed usage (PRN) inhalation per day was 843 (55.5%); the mean frequency of PRN use was 0.25±0.67 inhalations per day. The number of patients who overused for at least 1 day was 260 (17.1%). In particular, young patients, patients with limited physical activity, and patients with nocturnal symptoms demonstrated high frequency of overuse. The frequency of overuse during SMART was not high in Korean asthmatic patients and the asthma status of follow-up outpatients improved overall. However, there is a need for careful education targeted toward younger patients, patients with limited physical activity, and patients with nocturnal symptoms owing to their tendency to frequently overuse.
Subject(s)
Humans , Asthma , Budesonide , Education , Follow-Up Studies , Formoterol Fumarate , Inhalation , Korea , Motor Activity , Outpatients , Prescription Drug Overuse , Prospective StudiesABSTRACT
BACKGROUND AND PURPOSE: Middle East respiratory syndrome (MERS) has a high mortality rate and pandemic potential. However, the neurological manifestations of MERS have rarely been reported since it first emerged in 2012. METHODS: We evaluated four patients with laboratory-confirmed MERS coronavirus (CoV) infections who showed neurological complications during MERS treatment. These 4 patients were from a cohort of 23 patients who were treated at a single designated hospital during the 2015 outbreak in the Republic of Korea. The clinical presentations, laboratory findings, and prognoses are described. RESULTS: Four of the 23 admitted MERS patients reported neurological symptoms during or after MERS-CoV treatment. The potential diagnoses in these four cases included Bickerstaff's encephalitis overlapping with Guillain-Barré syndrome, intensive-care-unit-acquired weakness, or other toxic or infectious neuropathies. Neurological complications did not appear concomitantly with respiratory symptoms, instead being delayed by 2–3 weeks. CONCLUSIONS: Neuromuscular complications are not rare during MERS treatment, and they may have previously been underdiagnosed. Understanding the neurological manifestations is important in an infectious disease such as MERS, because these symptoms are rarely evaluated thoroughly during treatment, and they may interfere with the prognosis or require treatment modification.
Subject(s)
Humans , Cohort Studies , Communicable Diseases , Coronavirus , Coronavirus Infections , Diagnosis , Encephalitis , Guillain-Barre Syndrome , Middle East Respiratory Syndrome Coronavirus , Middle East , Mortality , Neurologic Manifestations , Pandemics , Peripheral Nervous System Diseases , Prognosis , Republic of KoreaABSTRACT
BACKGROUND: From May to July 2015, the Republic of Korea experienced the largest outbreak of Middle East respiratory syndrome (MERS) outside the Arabian Peninsula. A total of 186 patients, including 36 deaths, had been diagnosed with MERS-coronavirus (MERS-CoV) infection as of September 30th, 2015. MATERIALS AND METHODS: We obtained information of patients who were confirmed to have MERS-CoV infection. MERS-CoV infection was diagnosed using real-time reverse-transcriptase polymerase chain reaction assay. RESULTS: The median age of the patients was 55 years (range, 16 to 86). A total of 55.4% of the patients had one or more coexisting medical conditions. The most common symptom was fever (95.2%). At admission, leukopenia (42.6%), thrombocytopenia (46.6%), and elevation of aspartate aminotransferase (42.7%) were observed. Pneumonia was detected in 68.3% of patients at admission and developed in 80.8% during the disease course. Antiviral agents were used for 74.7% of patients. Mechanical ventilation, extracorporeal membrane oxygenation, and convalescent serum were employed for 24.5%, 7.1%, and 3.8% of patients, respectively. Older age, presence of coexisting medical conditions including diabetes or chronic lung disease, presence of dyspnea, hypotension, and leukocytosis at admission, and the use of mechanical ventilation were revealed to be independent predictors of death. CONCLUSION: The clinical features of MERS-CoV infection in the Republic of Korea were similar to those of previous outbreaks in the Middle East. However, the overall mortality rate (20.4%) was lower than that in previous reports. Enhanced surveillance and active management of patients during the outbreak may have resulted in improved outcomes.
Subject(s)
Humans , Antiviral Agents , Aspartate Aminotransferases , Coronavirus Infections , Disease Outbreaks , Dyspnea , Extracorporeal Membrane Oxygenation , Fever , Hypotension , Leukocytosis , Leukopenia , Lung Diseases , Middle East Respiratory Syndrome Coronavirus , Middle East , Mortality , Pneumonia , Polymerase Chain Reaction , Republic of Korea , Respiration, Artificial , ThrombocytopeniaABSTRACT
Vocal cord dysfunction is characterized by the paradoxical adduction of the vocal cord during inspiration, causing relapsing wheezing or stridor, chest tightness, shortness of breath, and coughing. If the patient exhibiting symptoms of asthma is not responsive to treatment, there is a need to test whether vocal cord dysfunction is complicated by asthma. Herein, we report a case of vocal cord dysfunction with acute respiratory failure in old age with underlying disease. The patient presented with resting dyspnea, an audible wheeze, and was first diagnosed with acute exacerbation of bronchial asthma. However, her symptoms were not controlled with medical treatment and laryngoscopy showed paradoxical adduction of the vocal cords. Sudden cardiopulmonary arrest occurred after meal on the day of laryngoscopic examination. Although successful cardiopulmonary resuscitation, the patient developed ventilator-associated pneumonia, and multiple organ failure, eventually leading to death. Because the case was fatal, a report is being issued.
Subject(s)
Humans , Asthma , Cardiopulmonary Resuscitation , Cough , Dyspnea , Heart Arrest , Laryngoscopy , Meals , Multiple Organ Failure , Pneumonia, Ventilator-Associated , Respiratory Insufficiency , Respiratory Sounds , Thorax , Vocal CordsABSTRACT
BACKGROUND: A new influenza A(H1N1) virus emerged and spread globally in 2009, and the rapid progression of pneumonia often required ICU care. We describe the cause analysis and clinical aspects of community acquired pneumonia during the period of the pandemic H1N1 influenza A. METHODS: We reviewed the medical records of 48 adult cases of community acquired pneumonia in which patients were admitted to a public health hospital in Seoul from August to November in 2009. The patients had confirmed H1N1 influenza A based on RT-PCR assay. RESULTS: Thirteen cases of the 48 (27.1%) were 2009 H1N1 RT-PCR positive patients and three (6.3%) of these cases were mixed viral and bacterial pneumonia patients. The mean age was younger and the PSI score was lower in H1N1 patients. Chest radiographic findings of ground glass opacity and interstitial marking were remarkable in H1N1 patients. Major complication events with ICU care or death occurred in 23.1% of the H1N1 positive group and 48.6% of the H1N1 negative group (p=0.202). The major complication group of H1N1 patients had a higher PSI score, lower platelet count, higher CRP and higher mixed bacterial co-infection. CONCLUSIONS: If patients were younger and showed a radiologic finding of interstitial marking or ground glass opacity, we could consider H1N1 influenza as the cause of community acquired pneumonia. A high PSI score, thrombocytopenia, increased CRP and bacterial co-infection were predictable factors of major complication.
Subject(s)
Adult , Humans , Coinfection , Glass , Influenza, Human , Medical Records , Pandemics , Platelet Count , Pneumonia , Pneumonia, Bacterial , Public Health , Thorax , Thrombocytopenia , VirusesABSTRACT
BACKGROUND: Melanoma antigen genes (MAGE) are expressed in many human malignant cells and are silent in normal tissues other than in testis and in placenta. But MAGE expression in benign lung diseases, such as pulmonary tuberculosis or cases with severe inflammation, needs further evaluation to overcome false-positive findings. We evaluated detection rates of the melanoma antigen genes (MAGE) RT-nested PCR in bronchoscopic washing samples from patients with benign lung disease, as well as in patients with malignancies. METHODS: Bronchial washing fluid from 122 patients was used for cytological examination and MAGE gene detection using RT-nested-PCR of common A1-6 mRNA. We compared the results from the RT-nested PCR and the pathologic or bacteriologic diagnosis. We also analyzed the expression rate and false positive rate of MAGE gene. RESULTS: Among 122 subjects, lung cancer was diagnosed in 23 patients and benign lung disease was diagnosed in 99 patients. In patients with lung cancer, the positive rate of MAGE expression was 47.8% (11/23) and in benign lung disease group, the expression rate was 14.1% (14/99). Among benign lung disease group, the expression rate of MAGE gene (25.0%) in patients with pulmonary tuberculosis (11/44) was especially high. CONCLUSION: MAGE A1-6 RT-nested PCR of bronchial washing fluid can be used as a complementary method in lung cancer, but that test results in a high false positive rate in tuberculosis patients.
Subject(s)
Humans , Inflammation , Lung Diseases , Lung Neoplasms , Melanoma , Placenta , Polymerase Chain Reaction , RNA, Messenger , Testis , Tuberculosis , Tuberculosis, PulmonaryABSTRACT
BACKGROUND: The increasing rate of drug-resistant tuberculosis (TB) is a threat to the public health and TB control. In Korea, about 75~80% of TB patients are treated in private hospitals and the rate has been continuously increasing since 2000. METHODS: On a retrospective basis, we enrolled 170 newly diagnosed with or retreated for multidrug-resistant TB (MDR-TB) in 2004 from 21 private hospitals. We extracted the following demographics and treatment history from patient medical records: initial treatment outcomes, cumulative survival rates, treatment outcomes, and prognostic factors. RESULTS: Of the 170 patients, the majority were male (64.1%), the mean age was 44.5 years old, and mean body-mass-index was 20.2 kg/m2. None of the patients tested positive for HIV. Eleven (6.5%) were confirmed to have extensively drug-resistant TB (XDR-TB) at treatment initiation. Treatment success rates were not different between XDR-TB (36.4%, 4/11) and non-XDR MDR-TB (51.6%, 82/159). Default rate was high, 21.8% (37/170). Far advanced disease on X-ray was a significant negative predictor of treatment success; advanced disease and low BMI were risk factors for all-cause mortality. CONCLUSION: In private hospitals in Korea, the proportion of XDR-TB in MDR-TB was comparable to previous data. The treatment success rate of MDR-/XDR-TB remains poor and the failure rate was quite high. Adequate TB control policies should be strengthened to prevent the further development and spread of MDR-/XDR-TB in Korea.
Subject(s)
Humans , Male , Demography , Extensively Drug-Resistant Tuberculosis , HIV , Hospitals, Private , Korea , Public Health , Retrospective Studies , Risk Factors , Survival Rate , Tuberculosis, Multidrug-ResistantABSTRACT
Charcoal has been commonly used for enteral detoxication although it causes few adverse effects. The major causes of morbidity and mortality secondary to activated charcoal therapy are pulmonary aspiration, gastrointestinal complication, and fluid and electrolyte abnormalities. Aspiration of charcoal is associated with pulmonary compromise due to increased microvascular permeability with concomitant lung edema, surfactant depletion, atelectasis, and obliterative bronchiolitis. Herein we report the case of a patient with acute respiratory distress syndrome with chemical pneumonitis after aspiration of activated charcoal in sorbitol with a review of the related literatures.
Subject(s)
Humans , Bronchiolitis , Capillary Permeability , Charcoal , Edema , Lung , Pneumonia , Pulmonary Atelectasis , Respiratory Distress Syndrome , SorbitolABSTRACT
Candida albicans as being ubiquitous human commensals produce a broad range infections depending on host immunity and its virulency, ranging from usually local mucous membrane infection to disseminated fatal candidiasis with multisystem organ failure. Recently, candidiasis of deep organ are an increasingly important nosocomial infection. Candida lung abscess is rare relatively. Most commonly, it has been stated that they are found accompanied by hematogenously disseminated candidiasis particularly in immuno- suppressed patient. Primary lung abscess caused by C. albicans has been reported in less then 15 case in worldwide, and therapeutic guideline is poorly defined. We experienced a case of a primary lung abscess by C. albicans which may developed after aspiration of oropharyngeal contents as the mechanism of entry in a malnourished elderly patient and which was treated successfully with drainage of the abscess following by administration of fluconazole for 4 weeks. Herein we report the case with a review of the literature.
Subject(s)
Aged , Humans , Abscess , Candida albicans , Candida , Candidiasis , Cross Infection , Drainage , Fluconazole , Lung Abscess , Lung , Malnutrition , Mucous MembraneABSTRACT
Lung adenocarcinoma is the cancer originated in terminal bronchiole or alveolar epithelium and its incidence is on the increase. The most common radiologic pattern of lung adenocarcinoma is peripheral nodule or mass, but it can be showed various findings such as hilar mass, consolidation, atelectasis or multicentric lesions. Sometimes it is difficult to differentiate lung adenocarcinoma from other diseases, especially pneumonia. We experienced three patients with lung adenocarcinoma, just only presented as pneumonic consolidation on chest X-ray and CT scan. The clinician should consider seriously lung adenocarcinoma including bronchioloalveolar carcinoma in patients who did not respond to antibiotics. And in such cases, pathologic diagnosis must be perfomed at proper time to confirm disease.
Subject(s)
Humans , Adenocarcinoma , Adenocarcinoma, Bronchiolo-Alveolar , Anti-Bacterial Agents , Bronchioles , Diagnosis , Epithelium , Incidence , Lung , Pneumonia , Pulmonary Atelectasis , Thorax , Tomography, X-Ray ComputedABSTRACT
OBJECTIVES: To prevent progression to fatal asthma it is essential to assess the severity of asthma and treat adequetely. But there was no objective index to evaluate the severity of airway inflammation in asthmatic patients, So we evaluated that serum ECP concentration is a objective parameter of airway inflammation in patients with acute severe asthmatic attack. METHODS: We measured the parameters of asthamtic severtity(clinical parameter, FEV1, arterial blood gas, peripheral blood eosinophil counts, and serum ECP levels) before and after antiasthmatic treatment in 9patients with acute severe asthmatic attack, And we compared serum ECP concentrations of severe asthmatic patients with those of control patients with mild to moderate severity. RESULTS: 1) The serum ECP levels in patients with acute asthmatic attacks compared to patients with mild to moderate, asthmatic severity were significantly increased. 2) The serum ECP levels and pheriperal blood eosinophil counts 2hours after antiasthmatic treatment were significantly lower than the value before treatment, but the total scores of clinical parameter, FEV1, and scores of arterial blood gases were not significantly different from the basal values, CONCLUSION: It is suggested that the serum ECP level is a objective parameter as a response to antiasthmatic treatment as well as a severity of airway inflammation in patients with acute asthmatic attack.