Diagnostic value of fractional exhaled nitric oxide combined with small airway function test for chronic cough / 中国基层医药

Objective:To investigate the value of fractional exhaled nitric oxide (FeNO) combined with small airway function test to replace bronchial provocation test and induced sputum test in differentiating cough variant asthma (CVA) from eosinophilic bronchitis (EB).Methods:The clinical data of 105 patients with chronic cough admitted to The Third People's Hospital of Hubei, Jianghan University from January 2018 to December 2021 were retrospectively analyzed. These patients consisted of 40 patients with CVA (CVA group), 25 patients with EB (EB group), and 40 patients with other chronic coughs (other chronic cough group). FeNO and lung function were compared between groups. The value of FeNO, small airway function, and their combination in differentiating CVA from EB were analyzed using the receiver operating characteristic curves.Results:FeNO level was the highest in the CVA group [33.0 (30.0, 37.8) ppb], followed by the EB group [28.0 (25.5, 32.0) ppb], and the lowest in other chronic cough group [13.0 (11.0, 15.0) ppb]. There was significant difference in FeNO level between groups ( H value = 79.00, P < 0.05). There were no significant differences in forced vital capacity (FVC), forced expiratory volume in 1 second (FEV 1), FEV 1/FVC, peak expiratory flow (PEF) between groups (all P > 0.05). Maximal mid-expiratory flow (MMEF) [74 (66.0, 77.4) in the CVA group, 80 (79.0, 83.3) in the EB group, 88.0 (86.4, 90.0) in other chronic coughs group], FEF25 (%) [70.0 (60.3, 75.1) in the CVA group, 78.0 (74.1, 85.0) in the EB group, 81.7 (78.9, 86.3) in other chronic coughs group], FEF50 (%) [75.2 (67.1, 80.8) in the CVA group, 80.6 (75.7, 85.9) in the EB group, 89.4 (87.0, 90.5) in other chronic coughs group], FEF75 (%) [76.4 (68.7, 85.8) in the CVA group, 80.9 (77.4, 89.7) in the EB group, 90.8 (87.2, 94.2) in other chronic coughs group] were significantly lower in the CVA group than those in other chronic coughs group. With the exception of FEF25 (%), MMEF (%), FEF50 (%), and FEF75 (%) were significantly lower in the EB group compared with other chronic coughs group. MMEF (%) and FEF25 (%) in the CVA group were significantly lower compared with the EB group. There were significant differences in MMEF (%), FEF50 (%), and FEF75 (%) between groups ( H = 62.82, 47.04, 47.41, 49.11, all P < 0.01). There were significant differences in FEF50 (%) and FEF75 (%) between CVA and EB groups (both P > 0.05). In binary logistic regression equation, FeNO and MMEF (%) were important indexes to distinguish CVA from EB ( P < 0.05). Bronchial provocation test and induced sputum test were used as the gold standard to distinguish CVA from EB. When FeNO and MMEF (%) were used separately to distinguish CVA from EB, the optimal threshold value was 30.0 ppb and 77.7 respectively, the area under the receiver operating characteristic curve was 0.77 and 0.82 respectively, the diagnostic sensitivity was 70% and 77.5% respectively, and the diagnostic specificity was 72% and 88% respectively. When FeNO and MMEF (%) were used in combination to distinguish CVA from EB, the area under the receiver operating characteristic curve was 0.89, and the diagnostic sensitivity and specificity was 75% and 96% respectively. Conclusion:FeNO and MMEF (%) can be used to distinguish CVA from EB. FeNO combined with MMEF (%) has a higher value in distinguishing CVA from EB than FeNO and MMEF alone.

Combined Allergic Bronchopulmonary Aspergillosis and Tropical Pulmonary Eosinophilia: A Rare Co-occurrence

Allergic bronchopulmonary aspergillosis (ABPA) and tropical pulmonary eosinophilia (TPE) are common lung diseases presenting with peripheral blood eosinophilia. Although these have been widely reported both from India and outside, simultaneous co-occurrence of the two diseases has not been reported so far. We hereby present a case of an elderly male, a known case of asthma, who was diagnosed to have concurrent ABPA and TPE. Partial clinical response as well as the persistence of eosinophilia after ABPA treatment raised the suspicion that subsequently led to the diagnosis of TPE. The concurrent treatment of both conditions led to satisfactory clinical and serological improvement.

Hiperinfección por Strongyloides stercoralis en un paciente joven con infección por HTLV-1 y colitis ulcerativa / Strongyloides stercolaris hyperinfection in a young patient with HTLV-1 infection and ulcerative colitis

Resumen La estrongiloidiasis es una infección causada por el parásito Strongyloides stercoralis (SS) y se asocia con una alta mortalidad en pacientes inmunosuprimidos debido a una diseminación larvaria y síndrome de hiperinfección. El compromiso de la mucosa gástrica es raro, pero cuando se presenta se caracteriza por sangrado digestivo y emesis persistente. A continuación, se presenta el caso de un paciente de 27 años con síntomas gastrointestinales, antecedente de infección por el virus linfotrópico humano de células T tipo 1 (HTLV-1) y colitis ulcerativa, quien desarrolló síndrome de hiperinfección por SS. Se describe la presentación clínica, diagnóstico, tratamiento y complicaciones derivadas del cuadro infeccioso.

Abstract Strongyloidiasis is an infection caused by the parasite Strongyloides stercolaris (SS) and is associated with high mortality in immunosuppressed patients due to larval spread and hyperinfection syndrome. Gastric mucosal involvement is rare, but when it occurs, it is characterized by digestive bleeding and persistent emesis. The following is the case of a 27-year-old patient with gastrointestinal symptoms, a history of HTLV-1 infection and ulcerative colitis, who developed hyperinfection syndrome with SS. The clinical presentation, diagnosis, treatment and complications arising from the infectious disease are described.

Clinical characteristics of 14 patients with chronic eosinophilic pneumonia / 中国医师杂志

Objective:To summarize the clinical characteristics of patients with chronic eosinophilic pneumonia (CEP), so as to provide reference for clinicians and improve the level of diagnosis and treatment.Methods:14 patients who met the diagnostic criteria of CEP in Xiangya Second Hospital of Central South University from January 2012 to July 2021 were analyzed retrospectively. Their clinical manifestations, laboratory examination, imaging characteristics, diagnosis and treatment were analyzed.Results:The male to female ratio of 14 patients with CEP was 6∶1, with a median age of 51 years. 3 patients had allergic rhinitis, sinusitis, rash and other allergic history. The course of the disease was about 4 months. The common symptoms included cough (14 cases), expectoration (13 cases), shortness of breath (10 cases), and occasional extrathoracic symptoms such as rash and lymphadenopathy (2 cases). Eight patients had abnormal pulmonary auscultation, mainly coarse respiratory sounds of both lungs and scattered dry and wet rales. The eosinophil count (EOS) in peripheral blood was increased in all patients, and the median EOS count was about 1.42×10 9/L. Total serum IgE increased in 11 patients, of which 10 cases were more than 1 000 ng/ml. Pulmonary function tests were performed in 11 patients, including 5 cases of normal pulmonary function, 3 cases of obstructive ventilation dysfunction and 3 cases of restrictive ventilation dysfunction. All 14 patients underwent lung computer tomography (CT) examination. Most of them (13 cases) were double lung infiltration. The pathological signs were mainly patch shadow (6 cases), ground glass shadow (4 cases), grid shadow (3 cases) and consolidation shadow (3 cases), and scattered nodule shadow (3 cases) was seen in some cases; Mediastinal or hilar lymphadenopathy occurred in 6 patients. 9 patients underwent bronchoscopic alveolar lavage (BAL) and cell classification and counting. Only 3 cases had EOS counts higher than the normal value (normal value<3%). 10 patients underwent bronchoscopic lung biopsy, and 6 patients had EOS infiltration in lung tissue. 9 patients were treated with glucocorticoids, 8 patients were treated with oral corticosteroids (OCS) (prednisone or methylprednisolone), and the initial dose was 30-50 mg; One case was treated with budesonide atomization alone; Five patients were not diagnosed with CEP, only used antibiotics or other symptomatic treatment, and did not use hormones. Conclusions:As a rare pulmonary disease, CEP has no specific clinical manifestations. The common symptoms are cough, expectoration, shortness of breath, etc, which is easily misdiagnosed. Laboratory tests often indicate increased peripheral blood EOS count and total IgE, and imaging usually shows diffuse infiltration in both lungs, with lymph node enlargement. OCS therapy is the first-line treatment for CEP. The short-term prognosis after OCS treatment is good, but it is prone to relapse. Some novel monoclonal antibody biologics can be used as alternative therapy.

Pseudotumor bronquial eosinofílico / Eosinophilic Bronchial Pseudotumor

Las eosinofilias pulmonares constituyen un grupo variado de entidades cuyo nexo común es la inflamación eosinofílica que puede o no asociarse a eosinofilia periférica. En ese reporte describimos una forma atípica y no descripta de presentación como "pseudotumor pulmonar" que remitió con tratamiento corticoesteroideo.

Pulmonary eosinophilia are a varied group of entities sharing the eosinophilic inflammation that may or may not be associated with peripheral eosinophilia. This report describes an atypical, undescribed presentation, the "pulmonary pseudotumor" which showed regression with corticosteroid treatment.

A Comparative Clinical Study On The Efficacy Of Vishwadi Leha And Bharangydi Leha In The Management Of Vataja Kasa W.s.r Tropical Pulmonary Eosinophilia

Vataja Kasa (presented by Shushka Kasa, Prasakta Vega, Shirah Shoola, Hrit Shoola, Parshwa Shoola, Swara Bheda and kshamana) has an increasing prevalence overtime due to the external influences such as industrialisation, urbanisation, environmental pollution and population explosion. Since it’s a demanding health concern, Vataja Kasa was taken up for the present clinical study and was approximately co-related to Tropical Pulmonary Eosinophilia (TPE) which is an immune hyper-responsiveness to microfilariae trapped in the lungs, characterised by paroxysmal nocturnal cough, breathlessness, wheezing, chest pain, scanty sputum production and eosinophilia. The study was conducted with the prime aim of assessing the efficacy of the trial drugs Vishwadi Leha and Bharangyadi Leha in the management of Vataja kasa – TPE. The Clinical trial included 40 patients of Vataja Kasa categorized into two groups (20 in each). In Group A-Vishwadi Leha (3 gms) and in Group B- Bharangyadi Leha (3 gms) were administered thrice daily along with quantity sufficient warm water after food for 30 days. The findings were recorded, assessed and graded accordingly on the 14th and 30th day. The results were analysed statistically for ‘p’ value using student’s paired t-test before and after treatment. Significant results (p<0.001) were observed in both groups. Comparative study between percentages of improvement in Group A showed 5% (based on subjective parameters) and 7% (based on objective parameters) more improvement than that of Group B. Based on the results, it was concluded that Vishwadi Leha has a slightly better result than Bharangyadi Leha in the management of Vataja Kasa-TPE.

Recurrent Eosinophilic Pneumonia Associated with Mesalazine Suppository in a Patient with Ulcerative Colitis / 대한소화기학회지

Mesalazine suppositories are widely used to treat ulcerative colitis and have a guaranteed safety profile, but although rare, they can cause pulmonary toxicity. A 35-year-old woman with ulcerative colitis was diagnosed to have acute eosinophilic pneumonia after 29 days of oral mesalazine use and improved after mesalazine and corticosteroid were withdrawn. Reintroduction of mesalazine suppositories resulted in acute eosinophilic pneumonia recurrence after 28 days. Mesalazine re-administration (even via a different route) in patients with a history of mesalazine-induced eosinophilic pneumonia should be undertaken cautiously, because eosinophilic pneumonia may recurrence.

Exogenous lipoid pneumonia presented by acute eosinophilic pneumonia

Exogenous lipoid pneumonia is an uncommon medical condition resulting from aspiration or inhalation of oily material. Generally, lipoid pneumonia has nonspecific clinical and radiological presentations, and may be misdiagnosed as bacterial pneumonia or lung cancer. We describe an unusual case of exogenous lipoid pneumonia accompanied by peripheral blood and pulmonary eosinophilia. A 63-year-old man was admitted with progressively worsening exertional dyspnea and productive cough for 5 days. A chest radiograph showed abnormalities in the lower lobe of the right lung, and a diagnosis of community-acquired pneumonia was made; intravenous antibiotics were administered. However, dyspnea and hypoxia gradually worsened and peripheral blood eosinophilia developed. A bronchoscopy was performed and bronchoalveolar lavage fluid analysis showed markedly increased numbers of eosinophils (40%). Subsequently, a comprehensive review of history revealed that he fell asleep with camellia oil in his mouth for 2 weeks to relieve foreign body sensation of the throat. Sputum and bronchoalveolar lavage fluid cytology showed the presence of lipid-laden macrophages. He was diagnosed with lipoid pneumonia and acute eosinophilic pneumonia. Chest radiograph and symptom were rapidly improved after treatment with intravenous methylprednisolone.

Drug-induced eosinophilic pneumonia in a patient with Crohn's disease: diagnosis and treatment using fraction of exhaled nitric oxide

Oral 5-aminosalicylic acid agents (mesalazine and sulfasalazine) and azathioprine are the mainstays of treatment for inflammatory bowel disease. Reports of pulmonary toxicity induced by oral 5-aminosalicylic acid agents or azathioprine in patients with inflammatory bowel disease are very rare; to date, only 38 cases have been reported worldwide. We, herein, report a case involving a 26-year-old man who was diagnosed with eosinophilic pneumonia after using mesalazine and azathioprine for the treatment of Crohn's disease and recovered after treatment. We also found that the fraction of exhaled nitric oxide level was elevated in this patient. After treatment, the fraction of exhaled nitric oxide level decreased and the symptoms improved. The present case shows that fraction of exhaled nitric oxide is related to the disease activity and treatment effectiveness of druginduced eosinophilic pneumonia.

Lavado broncoalveolar y derrame pleural con hipereosinofilia: caso clínico y revisión de la literatura / Chronic eosinophilic pneumonia: report of one case

Chronic eosinophilic pneumonia (CEP) is uncommon and predominantly seen in women. More than 6% of eosinophils in peripheral blood and more than 25% in bronchoalveolar lavage are diagnostic criteria. Secondary causes of hypereosinophilic pneumonia must be ruled out. We report a 72-year-old non-smoker man presenting in the emergency room with a history of cough, fever, and moderate dyspnea. He was not taking any medication. A chest-X ray showed a left lower lobe (LLL) consolidation, and was started on broad-spectrum antibiotics with a presumptive diagnosis of pneumonia. There was no improvement after therapy. A chest CT scan showed increased LLL consolidation and new left upper lobe ground glass opacities as well as a moderate left pleural effusion. Flexible bronchoscopy was performed and bronchoalveolar lavage showed 95% eosinophils, and had negative cultures. No parasites were identified. Transbronchial biopsies demonstrated eosinophil accumulation in alveoli and interstitium and pleural fluid was composed by 85% eosinophils. With the diagnosis of CEP, systemic corticosteroids were used with favorable clinical and radiological response.

Toxocara canis-Associated Myelitis with Eosinophilic Pneumonia

The existence of Toxocara canis-specific antibodies has recently been reported in patients with atopic myelitis. Here, we report the case of a 35-year-old male patient admitted with a chief complaint of right lower limb hypoesthesia lasting for a month. The patient was diagnosed with eosinophilic pneumonia 3 months ago, and a spine MRI revealed the presence of myelitis in the cervicothoracic cord. After confirming the presence of hyper-IgE-emia and Toxocara canis antibodies, the patient was treated with steroids and albendazole treatment, which improved his symptoms. To our knowledge, this is the first case of Toxocara canis-associated myelitis with eosinophilic pneumonia.

Clinical Characteristics and Factors Influencing the Occurrence of Acute Eosinophilic Pneumonia in Korean Military Personnel

Acute eosinophilic pneumonia (AEP) is an uncommon inflammatory lung disease, and limited data exist concerning the clinical characteristics and factors that influence its occurrence. We retrospectively reviewed the records of AEP patients treated at Korean military hospitals between January 2007 and December 2013. In total, 333 patients were identified; their median age was 22 years, and all were men. All patients presented with acute respiratory symptoms (cough, sputum, dyspnea, or fever) and had elevated levels of inflammatory markers including median values of 13,185/microL for white blood cell count and 9.51 mg/dL for C-reactive protein. All patients showed diffuse ground glass opacity/consolidation, and most had pleural effusion (n = 265; 80%) or interlobular septal thickening (n = 265; 85%) on chest computed tomography. Most patients had normal body mass index (n = 255; 77%), and only 30 (9%) patients had underlying diseases including rhinitis, asthma, or atopic dermatitis. Most patients had recently changed smoking habits (n = 288; 87%) and were Army personnel (n = 297; 89%).The AEP incidence was higher in the Army group compared to the Navy or Air Force group for every year (P = 0.002). Both the number of patients and patients with high illness severity (oxygen requirement, intensive care unit admission, and pneumonia severity score class > or = III) tended to increase as seasonal temperatures rose. We describe the clinical characteristics of AEP and demonstrate that AEP patients have recently changed smoking habits and work for the Army. There is an increasing tendency in the numbers of patients and those with higher AEP severity with rising seasonal temperatures.

Clinical Usefulness of Bronchoalveolar Lavage Cellular Analysis and Lymphocyte Subsets in Diffuse Interstitial Lung Diseases

BACKGROUND: Diffuse interstitial lung diseases (DILDs) form a part of a heterogeneous group of respiratory diseases. Bronchoalveolar lavage (BAL) analysis has been used for differential diagnosis of DILDs, but their clinical usefulness is controversial. The aim of this study was to investigate the clinical usefulness of BAL cellular analysis with lymphocyte subsets for the differential diagnosis of DILDs. METHODS: A total of 69 patients diagnosed with DILDs were enrolled. Basic demographic data, BAL cellular analysis with lymphocyte subsets, histology, and high resolution computed tomogram (HRCT) findings were analyzed and compared as per disease subgroup. RESULTS: Significant differences were found between groups in the proportion of neutrophils (P=0.0178), eosinophils (P=0.0003), T cells (P=0.0305), CD4 cells (P=0.0002), CD8 cells (P<0.0001), and CD4/CD8 ratio (P<0.0001). These findings were characteristic features of eosinophilic pneumonia and sarcoidosis. Other parameters were not significantly different between groups. At the cut-off value of 2.16 for sarcoidosis, CD4/CD8 ratio showed sensitivity of 91.7% (95% CI, 61.5-98.6%) and specificity of 84.2% (95% CI, 72.1-92.5%). CONCLUSIONS: Routine analysis of BAL lymphocyte subset may not provide any additional benefit for differential diagnosis of DILDs, except for conditions where BAL is specifically indicated, such as eosinophilic pneumonia or sarcoidosis.

Vitamin D Status in South Korean Military Personnel with Acute Eosinophilic Pneumonia: A Pilot Study / 결핵및호흡기질환

BACKGROUND: A relationship between low vitamin D levels and the development or outcomes of respiratory diseases has been identified. However, there is no data on the vitamin D status in patients with acute eosinophilic pneumonia (AEP). We evaluated the vitamin D status in patients with AEP among South Korean military personnel. METHODS: We prospectively compared the serum levels of total 25-hydroxyvitamin D [25(OH)D], 25(OH)D3, and 25(OH)D2 among patients with AEP, pulmonary tuberculosis (PTB), and community-acquired pneumonia (CAP). RESULTS: In total, 65 patients with respiratory diseases, including AEP (n=24), PTB (n=19), and CAP (n=22), were identified. Of the 24 patients with AEP, 2 (8%) had deficient total 25(OH)D levels ( or =10 to or =30 to <100 ng/mL). The difference in the total 25(OH)D levels among patients with AEP, PTB, and CAP was not statistically significant (p=0.230). The median levels of total 25(OH)D, 25(OH)D3, and 25(OH)D2 were 22.84, 22.84, and 0.00 ng/mL, respectively, and no differences in the 25(OH)D level were present among patients with AEP, PTB, and CAP with the exception of the total 25(OH)D level between patients with AEP and PTB (p=0.042). CONCLUSION: We have shown that low vitamin D levels are frequently found in patients with AEP and are comparable with those in patients with PTB and CAP.

Loeffler's Syndrome Induced by Ingestion of Urushiol Chicken / 결핵및호흡기질환

Eosinophilic lung diseases are heterogeneous disorders characterized by varying degrees of pulmonary parenchyma or blood eosinophilia. Causes of eosinophilic lung diseases range from drug ingestion to parasitic or fungal infection as well as idiopathic. The exact pathogenesis of eosinophilic lung disease remains unknown. Urushiol chicken can frequently cause allergic reactions. Contact dermatitis (both local and systemic) represents the most-common side effect of urushiol chicken ingestion. However, there has been no previous report of lung involvement following urushiol chicken ingestion until now. A 66-year-old male was admitted to our hospital with exertional dyspnea. Serial chest X-ray revealed multiple migrating infiltrations in both lung fields, with eosinophilic infiltration revealed by lung biopsy. The patient had ingested urushiol chicken on two occasions within the 2 weeks immediately prior to disease onset. His symptoms and migrating lung lesions were resolved following administration of oral corticosteroids.

A clinical analysis of twenty-five cases of eosinophilic lung disease / 中华内科杂志

Objective To improve the diagnosis and treatment of eosinophilic lung disease.Methods Patients who were diagnosed with eosinophilic lung disease and hospitalized in the First Affiliated Hospital of Guangxi Medical University Hospital were retrospectively analyzed from January 2004 to August 2012.Data of etiology,clinical manifestation,imaging and pathological features,diagnosis and treatment were recorded.Results A total of 25 patients were diagnosed with eosinophilic lung disease including 9 chronic eosinophilic pneumonia,6 churg-strauss syndrome,and 10 cases of parasitic infection of which two patients were the simple pulmonary eosinophilia (L(o)ffler syndrome).Eosinophil counts in peripheral blood and bronchoalveolar lavage fluid (BALF) were increased.Arterial gas analysis showed varying degree of hypoxemia,which pulmonary function tests showed restrictive,obstructive,mixed ventilatory dysfunction.Chest CT showed bilateral flaky,streak or flake diffuse ground-glass infiltrates and reticular opacities.Results of pulmonary biopsy or skin biopsy identified diffuse eosinophil infiltration.Corticoidsteroid therapy alone or combined with immunosuppressive agents were both effective.Conclusion (1) Liver fluke and other food-borne parasites are the most common causes in eosinophilic lung disease; followed by unexplained chronic acidophilic granulocyte pneumonia; (2) In addition to histopathological evidence,the diagnosis of eosinophilic lung disease was made comprehensively based on clinical features,laboratory test,the BALF analysis,and imaging data.

A Case of Chronic Cough with Progressive Breathlessness in a 32 Year-old Male Health worker- Tuberculosis?, Allergic Bronchitis? Asthma?

Introduction: Although tuberculosis is hyper-endemic in India and is responsible for a huge proportion of respiratory morbidity, adequate workup should be conducted to rule out other differential diagnosis wherever applicable. Case Report: A 32 year old male health worker was suffering from productive cough and gradually increasing breathlessness since three months. The investigations conducted were a sputum analysis and a chest x-ray, both of which were normal and hence he was treated as a case of allergic bronchitis. Subject presented to us after three months with no relief. We further investigated him and found severe eosinophilia in the peripheral blood, a positive anti-filarial antibody and a negative triple stool test for ova and parasites. He was treated with diethylcarbamazine and albendazole+ivermectin combination. The patient responded well and had no complaints at the end of the 4 week treatment. Discussion and Conclusion: The subject should have been evaluated by conducting a basic investigation like a complete blood count. Delay in treatment of cases of tropical pulmonary eosinophilia can lead to permanent respiratory morbidity.

Effects of prednisone on eosinophilic bronchitis in asthma: a systematic review and meta-analysis, / Efeitos da prednisona na bronquite eosinofílica na asma: revisão sistemática e meta-análise

OBJECTIVE: To evaluate the effect size of oral corticosteroid treatment on eosinophilic bronchitis in asthma, through systematic review and meta-analysis. METHODS: We systematically reviewed articles in the Medline, Cochrane Controlled Trials Register, EMBASE, and LILACS databases. We selected studies meeting the following criteria: comparing at least two groups or time points (prednisone vs. control, prednisone vs. another drug, or pre- vs. post-treatment with prednisone); and evaluating parameters before and after prednisone use, including values for sputum eosinophils, sputum eosinophil cationic protein (ECP), and sputum IL-5-with or without values for post-bronchodilator FEV1-with corresponding 95% CIs or with sufficient data for calculation. The independent variables were the use, dose, and duration of prednisone treatment. The outcomes evaluated were sputum eosinophils, IL-5, and ECP, as well as post-bronchodilator FEV1. RESULTS: The pooled analysis of the pre- vs. post-treatment data revealed a significant mean reduction in sputum eosinophils (↓8.18%; 95% CI: 7.69-8.67; p < 0.001), sputum IL-5 (↓83.64 pg/mL; 95% CI: 52.45-114.83; p < 0.001), and sputum ECP (↓267.60 µg/L; 95% CI: 244.57-290.63; p < 0.0001), as well as a significant mean increase in post-bronchodilator FEV1 (↑8.09%; 95% CI: 5.35-10.83; p < 0.001). CONCLUSIONS: In patients with moderate-to-severe eosinophilic bronchitis, treatment with prednisone caused a significant reduction in sputum eosinophil counts, as well as in the sputum levels of IL-5 and ECP. This reduction in the inflammatory response was accompanied by a significant increase in post-bronchodilator FEV1. .

OBJETIVO: Avaliar o tamanho do efeito do tratamento com prednisona oral na bronquite eosinofílica na asma por meio de revisão sistemática e meta-análise. MÉTODOS: Revisão sistemática de artigos nas bases de dados do Medline, Cochrane Controlled Trials Register, EMBASE e LILACS. Foram selecionados estudos que preencheram os seguintes critérios: comparar ao menos dois grupos ou dois momentos (prednisona vs. controle, prednisona vs. outra droga ou pré vs. pós-tratamento com prednisona) e avaliar parâmetros antes e depois do uso de prednisona, incluindo eosinófilos, proteína catiônica eosinofílica (PCE) e IL-5 no escarro - com ou sem valores de VEF1 pós-broncodilatador - com os IC95% correspondentes ou com dados suficientes para calculá-los. As variáveis independentes foram uso e dose de prednisona e duração do tratamento. Os desfechos avaliados foram eosinófilos, IL-5 e PCE no escarro, bem como VEF1 pós-broncodilatador. RESULTADOS: A análise conjunta dos dados de pré e pós-tratamento revelou uma redução significativa nas médias de eosinófilos no escarro (↓8,18%; IC95%: 7,69-8,67; p < 0,001), IL-5 no escarro (↓83,64 pg/mL; IC95%: 52,45-114,83; p < 0,001), PCE no escarro (↓267,60 μg/L; IC95%: 244,57-290,93; p < 0,001), assim como um aumento significativo na média de VEF1 pós-broncodilatador (↑8,09%; IC95%: 5,35-10,83; p < 0,001). CONCLUSÕES: Em pacientes com bronquite eosinofílica de moderada a grave, o tratamento com prednisona determinou uma redução significativa nos níveis de eosinófilos no escarro, assim como nos níveis de IL-5 e PCE no escarro. Essa redução na resposta inflamatória foi acompanhada de um aumento significativo do VEF1 pós-broncodilatador. .

Acute Eosinophilic Pneumonia Following Secondhand Cigarette Smoke Exposure / 결핵및호흡기질환

Acute eosinophilic pneumonia (AEP) is a disease characterized by an acute febrile onset, eosinophilia in bronchoalveolar lavage fluid, and a dramatic response to corticosteroids. Although many studies have reported a close relationship between direct cigarette smoking and AEP, few studies have identified an association between passive smoking and AEP. Here, we report a case of AEP in a 19-year-old female with cough, fever, and dyspnea after 4 weeks of intense exposure to secondhand smoke for 6 to 8 hours a day in an enclosed area.

Tropical pulmonary eosinophilia - A review.

Tropical pulmonary eosinophilia (TPE) is a syndrome of wheezing, fever and eosiniphilia seen predominantly in the Indian subcontinent and other tropical areas. Its etiological link with Wuchereria bancrofti and Brugia malayi has been well established. The pathogenesis is due to an exaggerated immune response to the filarial antigens which includes type I, type III and type IV reactions with eosinophils playing a pivotal role. Peripheral blood eosinophilia is usually striking with levels over 3000/μl being common. High serum levels of IgE and filarial-specific IgE and IgG are also found. The pathology may vary from an acute eosinophilic alveolitis to histiocytic infiltration depending on the stage of the disease. While earlier studies had suggested that the disease runs a benign course, more recent work has shown that untreated TPE could result in a fair degree of respiratory morbidity. Pulmonary function tests may show a mixed restrictive and obstructive abnormality with a reduction in diffusion capacity. The bronchoalveolar lavage (BAL) eosinophil count has a negative correlation with the diffusion capacity. Treatment consists of diethylcarbamazine (DEC) for at least three weeks. Despite treatment with DEC, about 20 per cent of patients may relapse. Steroids have shown to have a beneficial effect but the exact dose and duration is yet to be confirmed by randomized controlled trials. A specific and easily available marker is required for TPE in order to distinguish it from other parasitic and non-parasitic causes of pulmonary eosinophilia.