Cases reported "Asthma"

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1/18. asthma: a case study, review of pathophysiology, and management strategies.

    PURPOSE: To review the pathophysiology of asthma, present a case study, and provide management strategies for treating this common, yet complex disorder in children and adults. DATA SOURCES: Selected clinical guidelines, clinical articles, and research studies. CONCLUSIONS: asthma is a chronic inflammatory airway disorder with acute exacerbations that currently affects approximately 14 million-15 million children and adults in the united states. Costs for asthma are staggering and nurse practitioners (NPs) are frequently presented with management decisions for the acute treatment and chronic management of this disorder. Disparities exist with the occurrence of asthma between race and gender. Additionally, there is an increased incidence in acute exacerbations resulting from poor long-term control and follow-up care among the socioeconomically disadvantaged. IMPLICATIONS FOR PRACTICE: Standards of care, along with new and emerging treatment strategies, guide NPs in providing the most comprehensive care to those affected with this chronic disorder. knowledge about the pathophysiology of asthma and correlated to the case presentation enhances understanding treatment strategies for NPs who are often faced with providing care for patients with this chronic disorder that may sometimes present in an acute exacerbation.
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2/18. Cleaning products and work-related asthma.

    To describe the characteristics of individuals with work-related asthma associated with exposure to cleaning products, data from the california-, massachusetts-, michigan-, and new jersey state-based surveillance systems of work-related asthma were used to identify cases of asthma associated with exposure to cleaning products at work. From 1993 to 1997, 236 (12%) of the 1915 confirmed cases of work-related asthma identified by the four states were associated with exposure to cleaning products. Eighty percent of the reports were of new-onset asthma and 20% were work-aggravated asthma. Among the new-onset cases, 22% were consistent with reactive airways dysfunction syndrome. Individuals identified were generally women (75%), white non-Hispanic (68%), and 45 years or older (64%). Their most likely exposure had been in medical settings (39%), schools (13%), or hotels (6%), and they were most likely to work as janitor/cleaners (22%), nurse/nurses' aides (20%), or clerical staff (13%). However, cases were reported with exposure to cleaning products across a wide range of job titles. Cleaning products contain a diverse group of chemicals that are used in a wide range of industries and occupations as well as in the home. Their potential to cause or aggravate asthma has recently been recognized. Further work to characterize the specific agents and the circumstances of their use associated with asthma is needed. Additional research to investigate the frequency of adverse respiratory effects among regular users, such as housekeeping staff, is also needed. In the interim, we recommend attention to adequate ventilation, improved warning labels and material safety data sheets, and workplace training and education.
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3/18. psychophysiologic disorders in children and adolescents.

    Psychosomatic disorders in children and and adolescents is a topic that covers a wide variety of illnesses and one which is difficult if not impossible to define accurately. In general, chronic emotional states, often nonspecific, serve as strong contributors to the development of a physical illness. The particular illness is often dictated by varying degrees of biological predisposition in one physiological system-i.e., such a predisposition in the respiratory system may lead to asthma or in the gastrointestinal system to ulcerative colitis. In some cases the biological factor is large and the emotional factor minimal, while in other cases the reverse is true. In the early days of research in psychosomatic disorders it was widely believed that each disorder was accompanied by certain specific emotional problems. Further study has shown this is not true. It was also felt that many, if not most of these disorders could be cured by psychotherapy, and this also has proven to be a fallacy. we have moved more and more to the team approach. Since both psyche and soma are involved, more than one specialist is usually required. In children and adolescents this may involve a child psychiatrist, a pediatrician, an allergist or gastroenterologist, a social worker and a psychologist. It requires time and patience to form an effective and smoothly functioning team in which all members respect one another's potential contribution. Some examples of team operation are presented and some of the problems outlined. In addition, there is attention given to the special problems of the adolescent and also the child with chronic nonspecific physical complaints as well as the child who requires hospitalization.
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4/18. Atopic disease in childhood.

    A child with atopy produces IgE antibodies after exposure to common environmental allergens. The atopic diseases (eczema, asthma and rhinoconjunctivitis) are clinical syndromes each defined by a group of symptoms and signs. Not all children with atopy will have atopic disease or develop symptoms after exposure to an allergen. Both genetic and environmental factors determine the development of atopic disease. The presence of specific IgE antibodies to environmental allergens is determined with skin prick or radioallergosorbent testing in children with atopy. Test results should be interpreted in the context of the clinical history and further investigations (eg, allergen avoidance or challenge). Management of atopic disease is frequently symptomatic, but it is important to avoid identified allergen triggers. immunotherapy may be considered in selected school-age children with severe rhinoconjunctivitis. Preventing atopic disease in high-risk infants and hindering progression of disease in children with established disease are the areas of active research.
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5/18. Baker's asthma with a predominant clinical response to rye flour.

    BACKGROUND: Relatively little attention has been paid to rye flour as opposed to wheat flour in clinical and epidemiological research into Baker's asthma. methods: This report describes the investigation of a baker with asthma who reported a workplace response to rye flour and none to wheat flour, despite co-reactivity to both wheat and rye antigen. RESULTS: Skin prick tests, RASTs and basophil stimulation tests were positive for both wheat and rye antigen, but quantitatively greater for rye than wheat. Bronchial challenge elicited a much greater response to the rye-wheat flour mix used in the bakery than to 100% wheat flour. CONCLUSIONS: The greater clinical response to rye than to wheat may be immunologically mediated, but could also be due to physical characteristics of rye flour such as greater dose of inhaled airborne particles or an irritative effect. This information may be useful for medical management and occupational hygiene control, and should stimulate further research into rye flour in Baker's asthma.
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6/18. Pediatric interstitial lung disease masquerading as difficult asthma: management dilemmas for rare lung disease in children.

    Idiopathic nontransplant-related childhood bronchiolitis obliterans is an uncommon disease. Most patients present with chronic recurrent dyspnea, cough and wheezing, which are also features of asthma, by far a much more common condition. The present case study reports on a six-year-old girl who presented to a tertiary care centre with recurrent episodes of respiratory distress on a background of baseline tachypnea, chronic hypoxemia and exertional dyspnea. Her past medical history revealed significant lung disease in infancy, including respiratory syncytial virus bronchiolitis and repaired gastroesophageal reflux. She was treated for 'asthma exacerbations' throughout her early childhood years. bronchiolitis obliterans was subsequently diagnosed with an open lung biopsy. She did not have sustained improvement with systemic corticosteroids, hydroxychloroquine or clarithromycin. cardiac catheterization confirmed the presence of secondary pulmonary hypertension. Treatment options remain a dilemma for this patient because there is no known effective treatment for this condition, and the natural history is not well understood. The present case demonstrates the need for careful workup in 'atypical asthma', and the urgent need for further research into the rare lung diseases of childhood.
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7/18. Professional cleaning and asthma.

    PURPOSE OF review: The purpose of this review is to summarize the recent evidence on the effect of cleaning jobs on asthma, based on case reports and series of occupational asthma among cleaners, and epidemiological studies on the relationship between different characteristics of cleaning and asthma risk, as well as to elaborate the evidence on potential occupational exposures responsible for the increased asthma risk observed in cleaners. RECENT FINDINGS: Six recent epidemiologic studies strengthen the evidence that domestic and industrial cleaners are at higher risk of asthma compared with professional employees in europe and the united states. These studies take into account individual confounders, such as age and cigarette smoking. This finding is supported by case reports and registry-based studies of occupational asthma. The studies and reports have identified some chemicals, such as bleach, as specific causes of asthma. Increased risk of asthma has also been related to some specific job tasks, such as cleaning windows and washing dishes. SUMMARY: Recent studies strengthen the evidence of an increased asthma risk among cleaners or individuals in other jobs in which they are involved in cleaning. Further research should be directed to elaborate how much of asthma is related to specific sensitization to certain chemicals and how much to airway inflammation induced by exposure to a mixture of irritants.
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8/18. Unanswered questions and warnings involving anti-immunoglobulin e therapy based on 2-year observation of clinical experience.

    The relatively rapid development and deployment of a clinically useful monoclonal antibody omalizumab has produced a number of questions still not answered despite massive research and many clinical trials. The mechanism of action as down-regulation of FceR1 receptors in the presence of low free immunoglobulin e (IgE) is incomplete. Some severe allergic asthmatic patients respond almost immediately, others take months, and some never respond. No accounting for the possible antigen sweeping by the complexes of IgG-IgE has been reported. skin tests may remain positive for much longer than reported, raising the possibility of anaphylaxis with concomitant specific immunotherapy. Two cases of anaphylaxis to specific immunotherapy while being "covered" with anti-IgE are reported. Total IgE levels do not always rise as expected, six cases of static IgE levels in responders are reported. Total IgE levels do not dependably predict usefulness. Current guidelines for anti-IgE use in asthmatic patients may require reexamination as data from broad clinical experience are gathered.
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9/18. Inhalant allergy following occupational exposure to blowflies.

    An allergic reaction, provoked by exposure to the blowfly Lucilia cuprina and shown to be IgE-mediated, occurred in a subject employed in an entomological research laboratory. The subject's serum, and sera from three other asthmatic patients with IgE antibodies to blowfly extracts, also reacted with extracts from the screw-worm fly (Chrysomya bezziana). Results suggested that antigens from the two species share immunological cross-reactivity. Cross-reactions also exist between the different developmental stages of both species. Allergic reactions to inhaled insect allergens may not be uncommon in the Australian community.
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10/18. Contact urticaria to locusts.

    We describe a case of allergic contact urticaria provoked by locusts in a laboratory research worker. One of her colleagues also had locust-induced contact urticaria, and another had asthma provoked by locust exposure. Contact urticaria to locusts is an occupational hazard apparently well known to professional entomologists, but one which has not previously been described in the dermatological literature, to my knowledge.
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