The prevalence of exercise-induced bronchospasm in soccer player children, ages 7 to 16 years.
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This study represents an attempt to determine the prevalence of exercise-induced bronchospasm among soccer player children. A total of 234 soccer player boys of all soccer schools from Shahr-Rey enrolled in this study. They did not have any history of a recent or chronic respiratory tract disease, a history of allergic diseases, and history of bronchodilator drugs consumption during the 24 hours prior to the study. Pulmonary function test (PFT) was performed for each participant before exercise and 6 and 15 minutes after playing soccer. The diagnosis of EIB was by a decrease in forced expiratory volume in 1 second (FEV1) by at least 10% and in peak expiratory flow rate (PEFR) by at least 15% with exercise challenge. If there was reduction in one parameter alone, the participants were considered as prone to EIB. Considering both FEV1 and PEFR the prevalence of EIB was 2.1% and 18.4% were prone to EIB. If FEV1 or PEFR tests were used as criteria for diagnosis of airway obstruction, the prevalence of EIB would be 6% and 15.8%, respectively. There was no significant difference between the post of players, family history of allergic disease and EIB in soccer players. This study suggests that at least 2.1% of soccer players will develop bronchospasm even if they do not have any history of asthma and allergy. (+info)
Induced tolerance to nebulized colistin after severe reaction to the drug.
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Daily nebulized colistin therapy has been used as maintenance therapy for patients with chronic Pseudomonas aeruginosa infection and in treatment protocols aimed at eradicating early P aeruginosa infection. Colistin-induced nephrotoxicity and mild neurotoxic effects have been described but hypersensitivity reactions are rare. However, bronchial constriction has been reported associated with the inhalation of the antibiotic. We report the case of a 63-year-old man who had been diagnosed with bronchiectasis and bronchopleural fistula and who developed severe bronchospasm when using nebulized colistin. A skin prick test (80 mg/mL) with colistin was performed and was negative. An intradermal test was not performed due to its possible irritant effect. As our patient suffered from a tobramycin-resistant P aeruginosa infection, we started a procedure to induce tolerance to 80 mg colistin (8 mg, 16 mg, 24 mg, 32 mg, 40 mg, 80 mg) nebulized in 30-minutes-intervals. No changes in forced expiratory volume in 1 second values were observed and the patient continues on treatment twice daily after the tolerance induction with no new episodes of bronchospasm. We report the first successful procedure to induce tolerance to colistin after escalating doses of inhaled colistin. (+info)
Inhaled tobramycin solution-associated recurrent eosinophilia and severe persistent bronchospasm in a patient with cystic fibrosis: a case report.
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BACKGROUND: Delivery of tobramycin by inhalation to the lungs of patients with cystic fibrosis (CF) who are infected with Pseudomonas aeruginosa has been proven to be effective and safe. The aerosol administration allows high concentrations of tobramycin to be delivered to the site of infection with limited systemic absorption. In rare patients, systemic absorption of inhaled tobramycin may be significant enough to produce toxic effects, such as renal and vestibular toxicities. CASE PRESENTATION: We report a patient with CF who developed recurrent eosinophilia and severe persistent bronchospasm following repeated administration of preservative-free tobramycin by inhalation, beginning at 16 months of age. Also, he developed similar signs and symptoms when he was administered tobramycin intravenously on one occasion at 5 1/2 years. The patient had a history of environmental allergies. Temporal sequence of his signs and symptoms after each administration of tobramycin (similar to re-challenge testing), and his improvement after discontinuation of the drug strongly suggest an adverse drug reaction. CONCLUSION: Hypersensitivity reaction should be considered in patients who develop recurrent eosinophilia and deterioration of pulmonary function following the use of tobramycin by inhalation or by intravenous administration. (+info)
Adverse respiratory events infrequently leading to malpractice suits. A closed claims analysis.
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Adverse outcomes associated with respiratory events are the single largest class of injury in the American Society of Anesthesiologists Closed Claims Project (762 of the 2,046 cases, 37%). Inadequate ventilation, esophageal intubation, and difficult tracheal intubation are the most common mechanisms of respiratory-related adverse outcomes. An analysis of closed claims data regarding these mechanisms has been reported previously. This report is concerned with 300 claims for five other less common but important categories of respiratory-related adverse outcomes in which recurrent themes of management error or patterns of injury could be identified: airway trauma, pneumothorax, airway obstruction, aspiration, and bronchospasm. Airway trauma (97 claims, 5% of the database) was associated with difficult intubation in 41 (42%) of the cases and the most frequent sites of injury were the larynx, pharynx, and esophagus. Pneumothorax (67 cases, 3% of the database) was usually either needle-related (block or central vascular catheter placement) or airway management-related (instrumentation or barotrauma). Airway obstruction (56 claims, 3% of the database) occurred in the upper airway in 39 (70%) of the cases. Aspiration (56 claims, 3% of the database) usually occurred during general anesthesia, either during induction prior to tracheal intubation or during maintenance of anesthesia delivered via mask. Bronchospasm (40 claims, 2% of the database) tended to occur during induction of general anesthesia in patients with a history of asthma or chronic obstructive pulmonary disease and/or smoking. The incidence of severe injury (brain damage and death) among these cases in the five categories was 47% overall, ranging from 12% in airway trauma claims to nearly 90% in claims for airway obstruction and bronchospasm.(ABSTRACT TRUNCATED AT 250 WORDS) (+info)
Crosstalk between Gi and Gq/Gs pathways in airway smooth muscle regulates bronchial contractility and relaxation.
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Receptor-mediated airway smooth muscle (ASM) contraction via G(alphaq), and relaxation via G(alphas), underlie the bronchospastic features of asthma and its treatment. Asthma models show increased ASM G(alphai) expression, considered the basis for the proasthmatic phenotypes of enhanced bronchial hyperreactivity to contraction mediated by M(3)-muscarinic receptors and diminished relaxation mediated by beta(2)-adrenergic receptors (beta(2)ARs). A causal effect between G(i) expression and phenotype has not been established, nor have mechanisms whereby G(i) modulates G(q)/G(s) signaling. To delineate isolated effects of altered G(i), transgenic mice were generated overexpressing G(alphai2) or a G(alphai2) peptide inhibitor in ASM. Unexpectedly, G(alphai2) overexpression decreased contractility to methacholine, while G(alphai2) inhibition enhanced contraction. These opposite phenotypes resulted from different crosstalk loci within the G(q) signaling network: decreased phospholipase C and increased PKCalpha, respectively. G(alphai2) overexpression decreased beta(2)AR-mediated airway relaxation, while G(alphai2) inhibition increased this response, consistent with physiologically relevant coupling of this receptor to both G(s) and G(i). IL-13 transgenic mice (a model of asthma), which developed increased ASM G(alphai), displayed marked increases in airway hyperresponsiveness when G(alphai) function was inhibited. Increased G(alphai) in asthma is therefore a double-edged sword: a compensatory event mitigating against bronchial hyperreactivity, but a mechanism that evokes beta-agonist resistance. By selective intervention within these multipronged signaling modules, advantageous G(s)/G(q) activities could provide new asthma therapies. (+info)
Management of complications during moderate and deep sedation: respiratory and cardiovascular considerations.
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The risk for complications while providing moderate and deep sedation is greatest when caring for patients already medically compromised. It is reassuring that significant untoward events can generally be prevented by careful preoperative assessment, along with attentive intraoperative monitoring and support. Nevertheless, we must be prepared to manage untoward events should they arise. This continuing education article will review critical aspects of patient management of respiratory and cardiovascular complications. (+info)
Airway smooth muscle growth in asthma: proliferation, hypertrophy, and migration.
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Increased airway smooth muscle mass is present in fatal and non-fatal asthma. However, little information is available regarding the cellular mechanism (i.e., hyperplasia vs. hypertrophy). Even less information exists regarding the functional consequences of airway smooth muscle remodeling. It would appear that increased airway smooth muscle mass would tend to increase airway narrowing and airflow obstruction. However, the precise effects of increased airway smooth muscle mass on airway narrowing are not known. This review will consider the evidence for airway smooth muscle cell proliferation and hypertrophy in asthma, potential functional effects, and biochemical mechanisms. (+info)
Reduced spontaneous relaxation in immature guinea pig airway smooth muscle is associated with increased prostanoid release.
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