Fatal Hemoptysis Due to Endobronchial Aspergilloma in the Hyperinflated Native Lung after Single-Lung Transplantation for Lymphangioleiomyomatosis: A Case Report.

Pulmonary lymphangioleiomyomatosis accounts for the majority of cadaveric lung transplantation cases. Post-transplantation management is continuingly necessary not only to prevent the progression of LAM but also to address complications. A woman with lymphangioleiomyomatosis underwent cadaveric lung transplantation. She developed post-operative native lung hyperinflation and hemoptysis with cavity shadow in the native lung on computed tomography. Isolated Aspergillus from her sputum and positive Aspergillus galactomannan antigen in the blood led to a diagnosis of aspergillosis. Despite the reduction of hemoptysis by antifungal medication, she developed fatal hemoptysis. An autopsy showed an Aspergillus fungal mass in the bronchus in the native lung whilst the lung graft was free from lymphangioleiomyomatosis lesions. Endobronchial aspergilloma was suggested to be a cause of hemoptysis. This fatal clinical course suggested that hemoptysis due to endobronchial aspergilloma in the native lung should have been considered native lung pneumonectomy as a further intervention.

[Usage of gastric antisecretory drugs in palliative care of lung cancer patients].

Non-steroidal anti-inflammatory drugs(NSAID)and steroids are important drugs that are the most frequently prescribed medications for the relief of cancer pain. However, there is overwhelming evidence that these drugs cause various forms of gastric mucosal injury. Based on clinical experience, gastric antisecretory drugs such as the proton pump inhibitor(PPI)and the histamine-H2 receptor antagonist(H2RA)are widely used to avoid the gastrointestinal problems caused by NSAID and steroids. There are individual differences in how physicians use PPI and H2RA. In the present study, we retrospectively examined PPI and H2RA usage in the palliative care of 83 lung cancer patients, who were routinely prescribed an NSAID alone (single group)or a combination of an NSAID with a steroid(combination group). We also administered a questionnaire survey to 25 prescribing physicians specializing in respiratory medicine. The proportion of physicians prescribing a PPI prophylactically in the combination group was significantly higher than that of the single group. According to answers in the questionnaire survey, PPI prescribed by physicians in the single group was determined by the performance status and history of gastrointestinal problems in patients. Regardless of such factors, in the combination group, PPI was deliberately prescribed with steroids. Further investigation is needed to examine the clinical effects of PPI in palliative care, so as to establish more appropriate use of both PPI and H2RA.

[Evaluation of the symptoms, adherence and satisfaction after pharmaceutical care at asthma clinic for outpatient].

In the present study, we investigated whether counseling at an outpatient asthma clinic improved asthma symptoms, adherence and patient satisfaction: The asthma control test (ACT) and asthma control questionnaire (ACQ) were used to assess subjective symptoms, 10-item version of the drug attitude inventory (DAI-10) was used to determine medication adherence, and 8-item Japanese version of the client satisfaction questionnaire (CSQ-8J) was used to ascertain patient satisfaction. All scores of inhalation technique, PEF (peak expiratory flow) value/predicted PEF value (%), ACT, ACQ and DAI-10 in 26 patients with asthma increased after counseling at the outpatient asthma clinic compared to those before counseling. The average CSQ-8J score of 28 points (highest possible score: 32 points) indicated that the patients were satisfied with services provided by this clinic. These results indicate that counseling provided by pharmacists at the outpatient clinic is a valuable way improving subjective symptoms, lung function and medication adherence. These results also indicate that counseling at the asthma clinic by pharmacists improves the quality of life of patients with asthma.

[Pharmacy students' participation in medicinal education for children].

Over recent years, use of self-medication by patients to help prevent and treat their own medical conditions has become increasingly widespread. However, despite provision of warnings and the taking of precautions, health hazards due to medication have occurred and continue to occur. In order to ward off such incidents, it is necessary for both children and adults to be educated about appropriate drug use. And, it is desirable that pharmacy students participate in this medicinal education as a means of affirming what they have learned and improving their communication skills at an early stage in their professional development. In 2008, we held medicinal education classes for pupils and parents at three elementary schools in Aichi Prefecture with the aim of promoting appropriate drug use. Each class comprised of two parts: an introductory lecture in quiz form, lasting about 30 minutes, and a 30-minute participatory group experiment. Subsequently, the activities carried out in both parts were evaluated across 6 items and 3 items respectively, and scored from Satisfied to Unsatisfied (4-step scale) by the pupils and their parents. We also conducted a questionnaire survey on this activity to the pharmacy students. We achieved successful results, gaining high Satisfied levels (better than 90%) in all items. This activity benefited both the children and the pharmacy students. It not only provided education for the general public regarding the appropriate drug use, but is also helping to foster the development in Japan of well-trained future pharmacists.