High Dose Rate Brachytherapy for Nonmalignant Airway Obstruction*New Treatment Option (original) (raw)
Related papers
exerCise-induCed BronChoConstriCtion–Current update and impliCations for treatinG athletes
Exercise-induced bronchoconstriction (EIB) is the occurence of transient airway narrowing that occurs during or after exercise. A number of pathophysio-logical theories exist for the condition, from physio-logical to inhaled air quality and nutrition, all with im-mune mediation. Detailed history and clinical evalu-ation are required to make the diagnosis, substanti-ated by investigations of lung function establishing minimum airway hyperresponsiveness or broncho-dilator response. Chronic management involves the prevention of acute attacks, which includes inhaled glucocorticosteroids and either long-and/or short-acting bronchodilators (beta 2 -agonists), and the use of non-pharmacological agents and methods. Acute asthma can be life-threatening and there are estab-lished guidelines on how to manage this. Prescribing and treating should bear in mind the current anti-dop-ing regulations of the World Anti-Doping Agency.
Severe Exertional Dyspnea in an Ex-Smoker with a Large Apical Bulla
Annals of the American Thoracic Society, 2018
The Clinical Challenge Definition of abbreviations: Cdyn = dynamic lung compliance; Cst = static lung compliance; DL CO = diffusing capacity of the lung for carbon monoxide; DL CO /VA = DL CO relative to alveolar volume; FEF 25-75% = forced expiratory flow between 25% and 75% of FVC; FEV 1 = forced expired volume in 1 s; FRC = functional residual capacity; FVC = forced vital capacity; IC = inspiratory capacity; LLN = lower limit normal value of reference population; MEP = maximum expiratory mouth pressure; MIP = maximum inspiratory mouth pressure; MVV = maximal voluntary ventilation; PEF = peak expiratory flow; RV = residual volume; sRaw = specific airway resistance; TLC = total lung capacity; VA = alveolar volume. Values are before and 4months after bullectomy. Values in parentheses represent % predicted normal values.
High Prevalence of Laryngeal Obstruction during Exercise in Severe Asthma
American Journal of Respiratory and Critical Care Medicine, 2019
patients with severe asthma is associated with a decline in pulmonary function (7). Epithelial repair requires cell migration, proliferation, and differentiation to restore the structure after injury (8). As progenitor/stem cells, basal cells play a critical role in epithelial repair and undergo proliferation and differentiation in response to injury. Because they showed a persisting expansion after BT, we evaluated their proliferation. We observed that the number of proliferative (Ki-67 1) p63 1 cells decreased >12 months after BT, whereas the total number of p63 1 cells remained high. These data suggest that the local proliferation of basal cells participated in the observed p63 1 cell expansion shortly after BT, and that later other sources of progenitor cells likely sustained the observed higher number of p63 1 cells (9). This real-life study did not have a control group, and patients were asked to undergo bronchial biopsies at the time of the BT procedures. However, we believe that bronchial biopsies taken in the left lower lobe at the first bronchoscopy for right lower lobe BT treatment constitute an acceptable baseline. In conclusion, in severe asthma, the bronchial epithelium could be considered as an important target of BT treatment. BT causes epithelial injury, induces proliferation of basal progenitor cells, reduces mucin expression, and improves epithelial integrity. These results support BT as an effective treatment option for patients with severe uncontrolled asthma, and suggest that the observed clinical benefits could be related to BT-induced changes of the bronchial epithelium structure in addition to airway mucosa smooth muscle mass and nerve fiber changes. n Author disclosures are available with the text of this letter at www.atsjournals.org. Acknowledgment: The authors thank the patients for their participation, Serge Simard for statistical analysis, Sophie Plante for technical help, Lyne Ringuette for patient recruitment, and Sabrina Biardel (Quebec Respiratory Health Network Tissue Bank) for providing tissue samples.
Practical approach to exercise-induced bronchoconstriction in athletes
Primary care respiratory journal : journal of the General Practice Airways Group, 2013
Exercise-induced bronchoconstriction (EIB) is highly prevalent in athletes of all abilities and can impact on their health and performance. The majority of athletes with exertional dyspnoea will be initially assessed and managed in primary care. This report provides a practical and pragmatic approach to the assessment and management of a young athlete presenting with suspected EIB in this setting.
The Journal of Allergy and Clinical Immunology: In Practice, 2020
AAAAI Position Statements, Work Group Reports, and Systematic Reviews are not to be considered to reflect current AAAAI standards or policy after five years from the date of publication. The statement below is not to be construed as dictating an exclusive course of action nor is it intended to replace the medical judgment of healthcare professionals. The unique circumstances of individual patients and environments are to be taken into account in any diagnosis and treatment plan. The statement reflects clinical and scientific advances as of the date of publication and is subject to change. For reference only. Exercise-induced bronchoconstriction, otherwise known as exercise-induced bronchoconstriction with asthma or without asthma, is an acute airway narrowing that occurs as a result of exercise and can occur in patients with asthma. A panel of members from the American Academy of Allergy, Asthma & Immunology Sports, Exercise, & Fitness Committee reviewed the diagnosis and management of exercise-induced bronchoconstriction in athletes of all skill levels including recreational athletes, high school and college athletes, and professional athletes. A special emphasis was placed on the recommendations and regulations set forth by professional athletic organizations after a detailed review of their collective bargaining agreements, substance abuse policies, antidoping program manuals, and the World Anti-Doping Agency antidoping code. The recommendations in this review are based on currently available evidence in addition to providing guidance for athletes of all skill levels as well as their treating physicians to better understand which pharmaceutical and
Are pulmonary bleb and bullae a contraindication for hyperbaric oxygen treatment?
Respiratory Medicine, 2008
Background: Air cysts or blebs in the lungs may predispose pulmonary barotrauma (PBT) by causing air trapping when there is a change in environmental pressure. The changes in the environmental pressure are also seen during hyperbaric oxygen treatments (HBOT). Aim: The aim of this study was to determine how patients were evaluated for pulmonary blebs or bullae, and PBT prevalence in different HBOT centers. Methods: HBOT centers were asked to participate in this study and a questionnaire was send via e-mail. A total of 98 centers responded to our questionnaire. Results: Sixty-five HBOT centers (66.3%) reported that they applied HBOT to the patients with air cysts in their lungs. X-ray was the most widely used screening method for patients with a history of a lung disease. The prevalence of PBT in theses centers was calculated as 0.00045%. Conclusions: Our survey demonstrated that (1) a significant portion of the HBO centers accept patients with pulmonary bleb or bullae, (2) although insufficient, X-ray is the mostly used screening tool for patients with a history of pulmonary disease and (3) the prevalence of pulmonary barotrauma is very low in HBOT. a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / r m e d Respiratory Medicine (2008) 102, 1145e1147
Where to from Here for Exercise-Induced Bronchoconstriction
Immunology and Allergy Clinics of North America, 2013
Injury of the epithelium is important in the development of exercise-induced bronchoconstriction (EIB). Airway injury in elite athletes may relate to the large volumes of air inspired during training. Dysregulation of water movement and balance in the airways may contribute to the pathology of EIB. Mast cells, eosinophils, and sensory nerve cells are all likely to be involved in EIB. Cysteinyl leukotrienes are the major mediators of EIB with prostaglandins (PGs) likely to play a role in attenuating (PGE 2) or enhancing (PGD 2) the response. Refractoriness after exercise may relate to desensitization of airway receptors rather than depletion of mediators. New and more sensitive technologies for assaying mediators and measuring changes in pulmonary function are becoming available and will improve our understanding of EIB. Continued Conflict of Interest: T.S. Hallstrand has received research grants from the NIH, American Lung Association, has served as a consultant for Amgen and TEVA pharmaceuticals, and has received lecture fees from Merck & Co.