Difficult to treatment asthma, is it really asthma? Is it really difficult?

With the judicious use of inhaled corticosteroids [ICS] and B2 agonists most patients with asthma are easily controlled and managed. However, approximately 5-10% of asthmatics did not respond to standard therapy and are classified as [difficult to treat asthma, DTA]. Many factors can contribute to poor response to conventional therapy. For these patients, a systematic approach is needed to identify false[non-genuine] DTA from true [genuine] intractable DTA. It is essential to sort through and address the above issues before reverting to other therapy. The aim of the present study is to evaluate a systematic approach to indentify the patients of false [non-genuine] to true [genuine] DTA and to recognize the underlying different precipitating factors. In apparently DTA there is a high prevalence of false [non-genuine] cases. Identification and management can be achieved by detailed systematic assessment

Re-emerging of colistin for treatment of nosocomial pneumonia due to gram negative multi-drug resistant pathogens in critically ill patients

Gram-negative [G-ve] bacilli, particularly Pseudomonas aeruginosa and Acinetobacter baumannii, are important opportunistic multidrug-resistant [MDR] pathogens in hospitalized patients, contributing to their morbidity and mortality. These organisms may still keep their sensitivity to colistin and allowed its use for these selective therapeutic indications. The aim of the present study is to evaluate and compare the effectiveness and safety of both combined intravenous [i.v.] colistin with aerosolized colistin versus i.v. colistin alone in nosocomial pneumonia due to MDR G-ve pathogens in critically ill patients. 40 Patients were hospitalized in ICU due to different etiologies. These patients experienced nosocomial pneumonia. The pathogenic organisms were G-ve MDR bacilli and only susceptible to colistin. The first group received both i.v. colistin with aerosolized colistin versus [vs] the second group who received i.v. colistin alone. Mortality was less in patients who received i.v. plus inhaled colistin. Colistin is a reasonable safe last-line therapeutic alternative for pneumonia due to MDR G-ve pathogens. Aerosolized colistin may be considered as a useful adjunctive to i.v. colistin