efficacy of a management protocol in reducing emergency visits and hospitalizations in chronic asthmatics

To assess whether a simple protocol used in the outpatient's asthma clinic was effective in reducing emergency room [ER] visits and hospitalizations in chronic asthmatics during a year of follow-up, and to evaluate which type of asthmatics, according to severity of asthma, may benefit more from the protocol. Prospective assessment of a simple protocol [consisted of combined medical and educational aspects in the form of corticosteroids inhalation as a monotherapy and correction of the pitfalls of inhalation technique] in reducing ER visits, and hospitalization in chronic asthmatics. It was performed in the outpatients asthma clinic at King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia. A total of 128 chronic asthmatics were evaluated and followed up for one year between January 1999 and March 2000. Between January 1999 and March 2000 the total number of ER visits, and hospitalizations in 128 chronic asthmatics in the year before the protocol were 269 and 85. This was reduced to 116 ER visits and 27 hospitalizations a year after the protocol, a 55.4%, and 68.2% reduction. While only 25% never attended ER before the protocol, almost 58.6% did not attend ER after the protocol. The proportion that visited ER more frequently [at least 3 times/year] decreased from 50.8-18%, a 65% reduction. Similarly, patients who did not require hospitalization increased from 62.5% up to 85.2%. Moreover, the proportion that was hospitalized more frequently [at least 3 times/year] decreased from 10.2% to as low as 0.8%. Mean paired differences for ER visits were -1.16 +/- 1.42 with 95% confidence interval extending from -1.412 to - 0.916 with a P value <0.001. Mean paired differences for hospitalization were -0.453 +/- 0.955 with 95% confidence interval extending from -0.620 to -0.286 with a P value <0.001. A simple protocol in outpatient's asthma clinic can significantly reduce ER visits and hospitalizations in chronic asthmatics. All asthmatics, irrespective of severity benefited significantly from the protocol

Bronchoscopy, indications, safety and complications

To review the safety, indications, complications of flexible fiberoptic bronchoscopies performed at university teaching hospital, and to correlate the bronchoscopic findings with radiology, histology, and history of smoking. A total of 124 consecutive flexible fiberoptic bronchoscopies were reviewed in the last 3 years. A special form that contains personal data, indications, premedications, route of insertion, bronchoscopic findings, and complications in subjects-undergone bronchoscopy was completed. A suspicion of pulmonary tuberculosis [31%], lung mass [19%] and hemoptysis [18%] were the most common indications. Hypoxemia [14%] during procedure and pneumothorax post procedure were the most common complications. Mortality rate was 0%. For 57% of subjects who had histology, lung cancer [44%], and tuberculosis [15.5%] were commonly found. Lung cancer [72%] and tuberculosis granuloma [18%] were mainly responsible for narrow segments during bronchoscopy. A radiological tumor like mass was found histopathologically to be as lung cancer in 86% and as tuberculous granuloma in 5%. About 84% of lung cancer patients were either smokers [57%] or ex-smokers [27%] as compared to only 35% in smokers and 13% in ex-smokers in patients without lung cancer, P-value<0.01. Flexible fiberoptic bronchoscopy can be performed safely whenever indicated. Complications occurred were minor and self limiting. Appropriate preparation, and close supervision and adherence to the protocol were essential for a successful and safe procedure

Isolated respiratory failure caused by myasthenia gravis

Isolated respiratory failure due to myasthenia gravis that selectively involved the respiratory muscles alone is extremely rare and difficult to diagnose. We reported herein, a 46 year old patient who presented with acute respiratory failure, 4 weeks after thymoma resection. The respiratory failure was due myasthenia gravis that selectively affected the respiratory muscles only without having any peripheral signs. The initial response to therapy with pyridostigmine was unexpectedly complicated with severe bradycardia that made insertion of permanent pacemaker essential, before further therapy

Isolated respiratory failure caused by myasthenia gravis

Isolated respiratory failure due to myasthenia gravis that selectively involved the respiratory muscles alone is extremely rare and difficult to diagnose. We reported herein, a 46 year old patient who presented with acute respiratory failure, 4 weeks after thymoma resection. The respiratory failure was due to myasthenia gravis that selectively affected the respiratory muscles only without having any peripheral signs. The initial response to therapy with pyridostigmine was unexpectedly complicated with severe bradycardia that made insertion of permanent pacemaker essential, before further therapy