Yasuo To

The utility of galactomannan antigen in the bronchial washing and serum for diagnosing pulmonary aspergillosis

BACKGROUND The diagnosis of pulmonary aspergillosis is difficult because the sensitivity of the conventional methods for the detection of Aspergillus such as culture and cytology, is poor. To improve the sensitivity for Aspergillus detection, the detection of galactomannan antigen has been investigated. The serum galactomannan (GM) antigen has been recognized to be a useful tool for the diagnosis of invasive pulmonary aspergillosis. However, the utility of the galactomannan antigen for the diagnosis of pulmonary aspergillosis other than invasive pulmonary aspergillosis (IPA) has been unclear. METHODS The GM antigen using serum and bronchial washing (BW) using bronchofiberscopy for the diagnosis of pulmonary aspergillosis other than IPA were measured. RESULTS In 45 enrolled patients, 7 patients had pulmonary aspergillosis, 5 of these patients had chronic necrotizing pulmonary aspergillosis and 2 patients had allergic bronchopulmonary aspergillosis. The area under the receiver operating characteristic (ROC) curve was 0.89 for the BW GM antigen detection test, and 0.41 for the serum GM antigen detection test, suggesting that the BW GM antigen detection test exhibits a better diagnostic performance than the serum GM antigen detection test. The BW GM antigen detection test had a sensitivity of 85.7% and a specificity of 76.3% at a cut-off level of ≥0.5, which was the optimal cut-off level obtained by the ROC curve. CONCLUSION The BW GM antigen detection test is thought to be a promising test for the diagnosis of pulmonary aspergillosis other than IPA.

Obesity-related systemic oxidative stress: An important factor of poor asthma control

Spirometry FVC (L) 2.53 ± 0.80 2.58 ± 0.93 0.907 %FVC (%) 83.2 ± 18.1 83.8 ± 13.8 0.881 FEV1 (L) 2.12 ± 0.71 2.13 ± 0.82 0.991 %FEV1 (%) 82.6 ± 22.5 85.1 ± 15.7 0.773 FEV1/FVC (%) 82.4 ± 9.9 81.8 ± 7.0 0.579 %PEF (%) 78.6 ± 21.6 81.9 ± 20.6 0.741 %FEF50 (%) 76.8 ± 42.4 83.4 ± 36.6 0.515 %FEF75 (%) 71.1 ± 43.7 64.7 ± 30.5 1.000 Serum markers Serum Leptin (ng/mL) 16.9 ± 11.3 27.3 ± 12.1 0.007 Serum MDA (mM) 2.8 ± 0.7 3.3 ± 0.8 0.034

Risk Factors of Local Oropharyngeal and Laryngeal Adverse Effects from Use of Single Inhaled Corticosteroids and Long-Acting Beta-Agonists

BACKGROUND Single inhaled corticosteroids and long-acting beta-agonists (ICS/LABA) are clinically effective and safe. However, if local oropharyngeal and laryngeal adverse effects (LOLAE) appear, adherence to the use of ICS is impaired. To minimize the development of adverse effects, it is essential to identify the underlying risk factors. METHODS The study included 481 asthmatic patients who were prescribed ICS/LABA for the first time in their life between January and September of 2010. Patients ranged in age from 14 to 86 years old and consisted of 281 never smokers and 200 smokers. All data were collected retrospectively by respirologists. RESULTS Seventy-three out of 481 patients suffered from one or more adverse effects, with 54 of these exhibiting LOLAE. Patients with LOLAE (51.4 ± 16.2 yrs) were significantly older than those without LOLAE (43.7 ± 15.9 yrs) (p = 0.0011) and were also prescribed a significantly higher dose of ICS. The pack-years of patients with LOLAE (2.1 ± 4.9) were significantly lower than those without LOLAE (6.0 ± 13.0) (p = 0.0087). The type of administered ICS was also significantly associated with a risk of developing LOLAE. CONCLUSIONS Our survey indicated that a greater age, a higher dose of ICS, and the type of ICS were potential risk factors of LOLAE. The identified factors should be considered in a clinical setting in order to prevent the development of LOLAE and provide optimal treatment to patients.

Obesity-associated severe asthma in an adult Japanese population

BACKGROUND Severe asthma is increasingly being recognized as an important public health issue. Obesity has been identified as a risk factor for poor asthma control and for worsening of asthma severity. However, most studies investigating obese patients with asthma have been performed in Western countries. Reports on the characteristics of obese Japanese individuals with severe asthma are lacking. Herein, we investigated the clinical characteristics of patients with obesity-associated severe asthma in a Japanese population and the association between obesity and poor asthma control. METHODS We conducted a retrospective observational study of adult patients with severe asthma. Patients were classified into two groups based on the definition of obesity recommended by the Japan Society for the Study of Obesity: obese (OB) group (body mass index [BMI] ≥25 kg/m2) and non-obese (NOB) group (BMI <25 kg/m2). The two groups were compared. The characteristics of obesity and the metabolic functions are known to differ between males and females; therefore, we analyzed male-only and female-only cohorts separately. RESULTS A total of 492 patients were enrolled. Age, smoking history in terms of number of pack-years, daily controller medications use, and spirometric data were not significantly different between the OB and NOB groups in either cohort. In the female cohort, the annual exacerbation ratio and the percentage of frequent exacerbators were significantly higher in the OB group compared to the NOB group. A multivariate logistic regression analysis showed that obesity was independently associated with frequent asthma exacerbations in the female cohort. CONCLUSIONS Our study revealed that obesity, defined as a BMI ≥25 kg/m2, was independently associated with poor asthma control (including acute exacerbations) in adult Japanese females with severe asthma.

Menthol-Flavored Cigarettes: Potentially a Strong Trigger of Acute Eosinophilic Pneumonia

Menthol-flavored cigarettes recently have received significant attention. Lower quit rates and higher relapse rates of smoking in people who smoke menthol-flavored cigarettes have been demonstrated. Additional disadvantages of menthol cigarettes also might exist. We present a lesson learned from a case we experienced: Menthol cigarette smoking might be a stronger trigger of acute eosinophilic pneumonia compared with nonflavored cigarette smoking. A 19-year-old man visited our hospital with a 3-day history of dry cough, dyspnea, and high fever. He had been completely healthy until the appearance of these symptoms. He had started smoking menthol cigarettes approximately 1 month before his visit to our hospital. He had no history of lung disease. He had no obvious history of occupational dust inhalation or illegal drug use. When he visited our outpatient department, his oxygen saturation was 88% while breathing room air. His temperature was 38.8 C. His complete blood count and blood chemistry findings were unremarkable, except for elevations in white blood cell count (14,900/mL), C-reactive protein (11.45 mg/dL), serum surfactant protein-D (259 ng/mL), and immunoglobulin-E (437 IU/mL). Chest x-ray and computed tomography scan showed patchy shadows and infiltration in both lungs and thickening of interlobular septa (Figure, A, B). Bronchoalveolar lavage findings showed marked elevation of eosinophils (total cell count 12.7 10/mL, eosinophils 67.6%) (Figure, C). The bronchoalveolar lavage eosinophil elevation, typical radiologic findings, and clinical history of symptom onset after initiation of cigarette smoking suggested a diagnosis of acute eosinophilic pneumonia. Systemic corticosteroid therapy resulted in resolution of his symptoms and radiologic findings (Figure, D). The patient was advised to stop smoking, but continued to smoke nonflavored cigarettes against the advice.