Allergic bronchopulmonary aspergillosis associated with eosinophilic gastroenteritis

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[Adverse reaction with immune mechanism induced by antituberculous drugs]. / Reactii adverse cu mecanism imunologic induse de medicamentele antituberculoase.

In every day medical practice, adverse immune reactions induced by antituberculous agents occur less frequently compared to toxic reactions. The risk of their appearance is significantly greater during individualized regimens. They include severe and potentially fatal reactions such as: anaphylaxis, toxic epidermal necrolysis, severe immune cytopenia, which must be rapidly recognized and monitored in intensive care. Reintroducing the therapeutic agent after suppressing the reaction can prove the causal relationship with an inductor. This diagnostic test (challenge test) is contraindicated for severe adverse drug reactions. The suspicion of an immune reaction during the treatment with antituberculous agents should be followed by the withdrawal of the suspected drug and pharmacological management according to the type and severity of the reaction; lately the antituberculous regimen will be reassessed.

[Measuring the quality of life in chronic obstructive respiratory diseases]. / Masurarea calitatii vietii în bolile respiratorii obstructive cronice.

Health-related quality of life (HRQL) has been an important field of research for the last 10 years, the result being several questionnaires used to measure it. Measuring HRQL is important in order to evaluate the impact of the disease on patient life, but in the same time it can be used to measure the therapeutic effect of pharmacological or non-pharmacological therapies (i.e. oxygen therapy, respiratory rehabilitation, lung transplant), in placebo-controlled or comparative studies, together with more classical measures (i.e. FEV1). In this paper we present the main questionnaires used to quantify the quality of life, including generic questionnaires and questionnaires specific to chronic respiratory diseases. We describe ways of administration, domains, scores, minimally clinical important difference (MCID), characteristics of a good questionnaire and basic informations regarding the main standardised respiratory questionnaires: AQLQ, CRDQ and SGRQ. We are finally focusing on the Romanian version of SGRQ (SGRQ-RO).

Parameters associated with persistent airflow obstruction in chronic severe asthma.

The significance of severe airflow obstruction in severe asthma is unclear. The current study determined whether severe airflow obstruction is related to inflammatory or structural changes in the airways. Patients with severe asthma from a tertiary referral clinic were divided into two groups according to their postbronchodilator forced expiratory volume in one second (FEV1): severe persistent airflow limitation (FEV1 <50% predicted; group S; n=37) and no obstruction (FEV1 >80% pred; group N; n=29). Smoking history, atopic status, lung function tests, exhaled NO, blood eosinophil count, quality of life scores using St George's Respiratory Questionnaire and high resolution computed tomography (HRCT) of the lungs were assessed. Patients from group S were older and had longer disease duration. There was no difference in smoking history, atopic status, hospital admissions, quality of life scores and amount of treatment with inhaled or oral corticosteroids. Exhaled NO and peripheral blood eosinophils were higher in group S (21.0 +/- 2.4 versus 12.8 +/- 2.3 ppb; 0.41 +/- 0.06 versus 0.15 +/- 0.03 x 10(9) cells x L(-1) respectively). HRCT scores for bronchial wall thickening and dilatation were higher in group S with no differences in air trapping. Peripheral blood eosinophilia and bronchial wall thickening on HRCT scan were the only parameters significantly and independently associated with persistent airflow obstruction. Patients with severe asthma and irreversible airflow obstruction had longer disease duration, a greater inflammatory process and more high resolution computed tomography airway abnormalities suggestive of airway remodelling, despite being on similar treatments and experiencing equivalent impairment in quality of life.

Failure of sputum eosinophilia after eotaxin inhalation in asthma.

BACKGROUND: Eotaxin is a chemokine specific for eosinophils and may play an important role in eosinophil recruitment in asthma. The effects of eotaxin inhalation on sputum and blood eosinophils, exhaled nitric oxide (NO), and bronchial responsiveness were determined. METHODS: Eotaxin was administered by nebulisation to asthma patients in three studies: (1) an open dose finding study with eotaxin (5, 10 and 20 microg) to two asthmatic subjects; (2) a randomised placebo controlled study with 20 microg eotaxin to five asthmatic subjects and five normal volunteers; and (3) a randomised placebo controlled study with 40 microg eotaxin to nine asthmatics. Forced expiratory volume in 1 second (FEV(1)), exhaled NO, and blood eosinophils were measured before and hourly for 5 hours after nebulisation and at 24 and 72 hours. Methacholine bronchial challenge and sputum induction were performed before and at 5, 24, and 72 hours after nebulisation. RESULTS: In the two placebo controlled studies there was no change in sputum eosinophil count and sputum eosinophilic cationic protein concentration after eotaxin inhalation compared with placebo. FEV(1), exhaled NO, and methacholine PC(20) did not change. However, high dose eotaxin (40 microg) induced an increase in sputum neutrophil count compared with placebo (p<0.05). CONCLUSIONS: Inhaled eotaxin up to 40 microg induced no changes in sputum eosinophil count but at 40 microg it increased the sputum neutrophil count. The significance of this finding is unknown.