Cases reported "Asthma"

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1/88. Pseudo-steroid resistant asthma.

    BACKGROUND: Steroid resistant asthma (SRA) represents a small subgroup of those patients who have asthma and who are difficult to manage. Two patients with apparent SRA are described, and 12 additional cases who were admitted to the same hospital are reviewed. methods: The subjects were selected from a tertiary hospital setting by review of all asthma patients admitted over a two year period. Subjects were defined as those who failed to respond to high doses of bronchodilators and oral glucocorticosteroids, as judged by subjective assessment, audible wheeze on examination, and serial peak flow measurements. RESULTS: In 11 of the 14 patients identified there was little to substantiate the diagnosis of severe or steroid resistant asthma apart from symptoms and upper respiratory wheeze. Useful tests to differentiate this group of patients from those with severe asthma appear to be: the inability to perform reproducible forced expiratory manoeuvres, normal airway resistance, and a concentration of histamine causing a 20% fall in the forced expiratory volume (FEV1) being within the range for normal subjects (PC20). Of the 14 subjects, four were health care staff and two reported childhood sexual abuse. CONCLUSION: Such patients are important to identify as they require supportive treatment which should not consist of high doses of glucocorticosteroids and beta2 adrenergic agonists. Diagnoses other than asthma, such as gastro-oesophageal reflux, hyperventilation, vocal cord dysfunction and sleep apnoea, should be sought as these may be a cause of glucocorticosteroid treatment failure and pseudo-SRA, and may respond to alternative treatment.
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ranking = 1
keywords = forced expiratory volume, expiratory volume, volume
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2/88. lung function during hoist rescue operations.

    INTRODUCTION: A case is presented in which a 43-year-old man suffering from a severe asthma attack, had ventilatory arrest during a hoisting procedure. Based on this experience, the influence of three hoisting techniques on lung function was tested. methods: The ventilatory capacity of 12 healthy volunteers was tested during three commonly used hoisting techniques: 1) single sling; 2) double sling; or 3) strapped to a stretcher. RESULTS: The vital capacity (VC) and the one-second, forced expiratory volume (FEV1) were reduced significantly during all hoisting techniques compared to the standing position. The reduction was significantly more pronounced on a stretcher than in either sling position. There were no differences in the FEV1 to VC ratio between the positions. CONCLUSION: The small reduction in ventilatory capacity during hoisting procedures is tolerated easily by healthy individuals, but should be taken into account when planning such procedures on patients with severe pulmonary disease.
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ranking = 1.0958700025473
keywords = forced expiratory volume, expiratory volume, vital capacity, capacity, volume
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3/88. Prehospital epinephrine overdose in a child resulting in ventricular dysrhythmias and myocardial ischemia.

    INTRODUCTION: epinephrine overdoses in children have been associated with supraventricular tachycardia. myocardial ischemia subsequent to epinephrine overdose has not been reported in pediatric patients. CASE REPORT: We report a case of ventricular dysrhythmias and myocardial ischemia in a 5-year-old boy who received 10 times the recommended dose of subcutaneous epinephrine. Prehospital providers administered the epinephrine, believing it was part of a "high-dose" epinephrine protocol. DISCUSSION: There is no role for high-dose epinephrine in the treatment of allergic reactions or asthma. Careful epinephrine dosing, using mg/kg and verifying the volume, dilution, and route of administration is essential to prevent epinephrine toxicity.
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ranking = 2.3238324711253E-5
keywords = volume
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4/88. Occupational neutrophilic asthma.

    Occupational asthma is typically associated with an eosinophilic bronchitis. The case of a 41-year-old woman who developed symptoms of asthma after occupational exposure to metal working fluids is reported. The diagnosis of asthma was confirmed by an forced expiratory volume in 1 s (FEV1) of 1.7 (59% predicted), with 11% reversibility after inhaled bronchodilator and a provocation concentration of methacholine to cause a fall in FEV1 of 20% (PC20) of 0.4 mg/mL. Induced sputum examination showed a marked neutrophilia. Over the next six months, serial sputum analyses confirmed the presence of a marked sterile neutrophilic bronchitis during periods of occupational exposure to metal working fluids, which resolved when the patient was away from work and recurred when she returned to work. The sputum findings were mirrored by corresponding changes in spirometry and PC20 methacholine. The findings indicate the occurrence of occupational asthma associated with an intense, sterile neutrophilic bronchitis after exposure to metal working fluids.
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keywords = forced expiratory volume, expiratory volume, volume
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5/88. vocal cord dysfunction in a child.

    vocal cord dysfunction (VCD) involves paradoxical adduction of the vocal cord during the respiratory cycle. This usually occurs during inspiration, but can also be seen in expiration. Vocal cord appositioning produces airflow obstruction sufficient to cause wheezing, shortness of breath, chest tightness, and coughing. These symptoms often imitate the respiratory alterations of asthma, thus leading to inappropriate treatment; intubation or tracheotomy may prove necessary. An 11-year-old girl was admitted with intractable dyspnea. She had been diagnosed with atopic asthma, although she failed to respond to an increase in antiasthma medication, including high-dose oral steroids. Flow-volume loops were abnormal, with evidence of variable extrathoracic airway obstruction, manifested as a flat inspiratory loop. No structural abnormalities were seen with either computed tomography (CT) or magnetic resonance imaging (MRI). Fibroscopy revealed paradoxical adduction of the vocal cords during the respiratory cycle, no obstructive disorder being observed. After the diagnosis of VCD, the clinical manifestations resolved with psychiatric treatment. Adduction was not demonstrable at repeat fibroscopy after treatment. VCD may simulate bronchial asthma; it may also be associated with that disorder, thus masking the diagnosis. It should be suspected in patients with recurrent wheezing who fail to respond to usual asthma treatment. An early diagnosis avoids unnecessary aggressive management. Treatment should consist of respiratory and phonatory exercises; psychotherapy may be useful.
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ranking = 2.3238324711253E-5
keywords = volume
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6/88. Left bronchial isomerism, normal atrial arrangement and bronchomalacia mimicking asthma: a new syndrome?

    Three children who presented with steroid-resistant airflow obstruction are described. They all had bronchomalacia in the setting of a rare visceral arrangement, namely left bronchial isomerism with normal atrial arrangement. Imaging and, in two cases, a normal residual volume in the face of severe airflow obstruction were diagnostic pointers to a nonasthmatic cause of wheeze. Although the association of these abnormalities may be coincidental, together they may constitute a new clinical syndrome.
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ranking = 2.3238324711253E-5
keywords = volume
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7/88. asthma due to inhaled chemical agents--the macrolide antibiotic spiramycin.

    One year after starting work in the pharmaceutical industry a 35-year-old non-atopic maintenance engineer developed attacks of sneezing, coughing and breathlessness. These occurred at home during the evening and early morning, never at work during the day. His employment involved contact with a wide variety of chemical agents including the macrolide antibiotic spiramycin. inhalation challenge tests carried out in hospital with gradually increasing quantities of spiramycin reproduced his symptoms and led to the development of late asthmatic reactions, during which the FEV1 fell by 25% and the FEV1/FVC ratio by 15%. No change occurred in the single breath CO transfer factor nor were crepitations heard over the lung fields which remained normal on chest X-ray. The patient showed positive immediate skin prick tests to spiramycin and developed blood eosinophilia during the late asthma attacks. inhalation of sodium cromoglycate either before, or before and hourly after the provocation challenge for 6 hr, failed to prevent the late asthma, although its onset was further delayed. On leaving the pharmaceutical industry the patient's symptoms improved but did not finally clear until his wife, who had worked in a clerical capacity in the same factory also ceased her employment.
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ranking = 0.00059644499565653
keywords = capacity
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8/88. Tracheal neurilemmoma mimicking bronchial asthma--a dilemma of difficult diagnosis: case report.

    Tracheal tumors are often overlooked as a cause of pulmonary symptoms until they reach an advanced state. They are often presented with a prolonged cough and shortness of breath. Most tracheal tumors in adults are cancerous (80% to 90%). Benign tracheal tumors are rare in adult patients. A case history is presented of a 19-year-old patient with a rare tracheal neurilemmoma. He was treated as having bronchial asthma initially, but his signs and symptoms did not improve with traditional therapy. The possibility of the presence of an upper airway obstruction was not raised until the typical "inspiratory tubular sound" was heard. Flow-volume loop testing, bronchoscopy, and three-dimensional computed tomography (3-D CT) confirmed the diagnosis of upper airway obstruction caused by a tracheal tumor. Therefore, surgical intervention rather than bronchoscopic removal was performed without difficulty. The patient was leading a stable life 8 months after a surgical resection. The presence of an upper airway obstruction can be proven by flow-volume loop testing and 3-D CT. Further pathologic confirmation can be accomplished by bronchoscopy. High suspicion of an upper airway obstruction such as a tracheal lesion should be raised when bronchial asthma patients fail to respond to conventional treatment.
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ranking = 4.6476649422505E-5
keywords = volume
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9/88. A family with extrinsic allergic alveolitis caused by wild city pigeons: A case report.

    We describe a family in which the mother died of unresolved lung disease and whose 5 children, some of whom had previous signs of asthma, were subsequently affected by extrinsic allergic alveolitis caused by contact with wild city pigeon antigens. The children received systemic corticosteroids for 1 month and inhaled steroids for 24 months, while antigen exposure was reduced as much as feasible. This was followed by a quick clinical recovery and a slow normalization of chest radiographs and pulmonary function indices, especially of diffusion capacity, during a follow-up of 24 months. Because pigeon-breeder's lung caused by free-roaming city pigeons has not been previously described, it remains unclear whether this family developed the disease because of high antigen exposure or because of increased susceptibility. None of the supposedly high-risk human leukocyte antigen types were found in the children. Whether human leukocyte antigen B7 in 1 child played a role in the course of the illness remains speculative. It is unknown to what extent pigeon-breeder's lung caused by nondomestic birds remains undetected and misdiagnosed as difficult or steroid-resistant asthma. The question remains whether free-roaming city pigeons are indeed a public health risk. We suggest that atypical outdoor antigens be considered in all patients with nonresolving chest disease or therapy-resistant asthma.
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ranking = 0.00059644499565653
keywords = capacity
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10/88. Symptomatic vascular rings in adulthood: an uncommon mimic of asthma.

    Symptomatic thoracic vascular rings presenting in adulthood are thought to be rare. During a 3-year time period, we diagnosed four cases of symptomatic vascular rings, which had been treated unsuccessfully for suspected asthma. spirometry was characterized by normal forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV1), and FEV1/FVC, decreased peak expiratory flow (PEF), and truncation of the expiratory flow volume loop. Chest radiographs revealed a right aortic arch in each case with computed tomography (CT) or magnetic resonance imaging (MRI) confirming the diagnosis of a vascular ring. The specific abnormalities consisted of right aortic arch with mirror branching of the main arteries and persistent ligamentum arteriosum; right aortic arch with diverticulum and a fibrous embryonic left arch; right aortic arch with aberrant left subclavian artery arising from a diverticulum of Kommerell; and a right aortic arch with persistent ligamentum arteriosum. Although they are uncommon, vascular rings first presenting in adulthood as a mimic of asthma are not rare. This diagnosis should be considered in adults when abnormal truncation of the flow-volume loop occurs or when radiographic aortic arch abnormalities are found.
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ranking = 1.2210858156021
keywords = forced expiratory volume, expiratory volume, forced vital capacity, vital capacity, capacity, volume
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