A case of acute respiratory failure in pregnancy.

Influenza is usually a benign, self-limiting illness. Occasionally influenza may be complicated by pneumonia. There is some impairment of cell-mediated immunity in pregnancy so that influenza pneumonia in pregnancy may rapidly progress to acute respiratory failure and other multisystem dysfunction. We present a case of influenza pneumonia in the third trimester of pregnancy in a normal host leading to acute respiratory failure which had a favorable outcome following standard supportive therapy.

Effect of inhaled triamcinolone on bronchial hyperreactivity and airways obstruction in asthma.

We measured changes in methacholine bronchial hyperreactivity and airways obstruction in 37 asthmatics treated with inhaled triamcinolone for 6 weeks. All received regular bronchodilator therapy but not steroids or cromolyn. Initial studies included spirometry and the provocative concentration of methacholine required to decrease the FEV1 by 20% (PC20). Patients were randomized into two groups: those given inhaled triamcinolone, 200 micrograms four times daily (T) by metered dose inhaler, and those given a placebo inhaler (P). Daily AM and PM peak flow measurements were recorded, while PC20 and pulmonary function tests were obtained at 3 and 6 weeks. Change in canister weight was used to determine treatment compliance. The PC20 of T increased from a baseline 1.00 mg/mL to 2.90 mg/mL at 6 weeks, whereas in P it decreased from 1.15 mg/mL to 1.05 mg/mL. Percent change in PC20 (delta PC20) for each patient was defined as: [(PC20(week 6)--PC20(baseline]/PC20 (baseline)] X 100. At 6 weeks, this was 290% in T versus 65% in P (P less than .05). Likewise, at 6 weeks T was significantly greater than P with respect to: delta FEV1 (4.1% versus -3.8%, P less than .05) and delta FEF25-75% (20.3% versus -5.6%, P less than .01). Patients were further separated into higher and lower complier subgroups. In T, higher compliers showed more improvement at 6 weeks than lower compliers in: delta PC20 (533.3 versus 67.8%, P less than .05), delta FEV1 (8.7 versus -1.7%, P less than .01), and delta FEF25-75% (31.9 versus 1.1%, P less than .01). These data suggest that triamcinolone improves bronchial hyperreactivity as well as airways obstruction.(ABSTRACT TRUNCATED AT 250 WORDS)

Captopril-induced hypersensitivity lung disease. An immune-complex-mediated phenomenon.

Captopril has not yet been included in the list of drugs causing hypersensitivity lung disease. We report a patient with hypertension, congestive heart failure, and chronic renal failure who, when rechallenged with captopril, developed upper lung field infiltrates associated with productive cough and striking peripheral eosinophilia. Gallium scan, transbronchial biopsy histologic findings, and direct immunofluorescent study were consistent with an immune-complex-mediated hypersensitivity reaction. There was no other etiology discovered for the patient's eosinophilia, nor was there evidence for an infectious etiology to explain his presentation.