Asthma is a chronic inflammatory disease of the airway that comprises a variety of etiologies and inflammatoryphenotypes. Clinically, there is a wide range of patients with varying severities and responses to individual drugs. Theintroduction of inhaled corticosteroid therapy has dramatically changed the treatment of asthma. Recent developmentof new therapies suggests the possibility of another breakthrough. These can be categorized as follows: anti-cytokinetherapies that usually target eosinophilic inflammation, sublingual immunotherapy, and bronchial thermoplasty. In thispaper, we will review the major articles related to asthma treatment that were published in 2013.
Background: Information regarding prognostic value of growth differentiation factor 15 (GDF-15) and heart-type fattyacid-binding protein (H-FABP) in patients with chronicobstructive pulmonary disease (COPD) exacerbation is limited. The aim of this study was to investigate whether serum levels of GDF-15 and H-FABP predict an adverse outcome forCOPD exacerbation. Methods: Clinical variables, including serum GDF-15 and H-FABP levels werecompared in prospectively enrolledpatients with COPD exacerbation that did or didnot experience an adverse outcome. An adverse outcome included 30-day mortalityand need for endotracheal intubation or inotropic support. Results: Ninety-seven patients were included and allocated into an adverseoutcome (n=10) or a control (n=87) group. Frequencies of mental change and PaCO2>37 mm Hg were significantly higher in the adverse outcome group (mentalchange: 30% vs. 6%, p=0.034 and PaCO2>37 mm Hg: 80% vs. 22%, p<0.001, respectively). Serum GDF-15 elevation (>1,600pg/mL) was more common in the adverse outcome group (80% vs. 43%, p=0.041). However, serumH-FABP level andfrequency of serum H-FABP elevation (>755 pg/mL) did not differ between the two groups. Multivariate analysis showedthat an elevated serum GDF-15 and PaCO2>37 mm Hg were significant predictors of an adverse outcome (odds ratio[OR],25.8; 95% confidence interval [CI], 2.7−243.8; p=0.005 and OR, 11.8; 95% CI, 1.2−115.3; p=0.034, respectively). Conclusion: Elevated serum GDF-15 level and PaCO2>37 mm Hg were found to predict an adverse outcomeindependently in patients with COPD exacerbation, suggestingthe possibility that serum GDF-15 could be used as aprognostic biomarker of COPD exacerbation.
Background: Transbronchial lung biopsy (TBLB) is a valuable diagnostic tool for peripheral pulmonary lesions. Thediagnostic yield of TBLB reportedly ranges from 41%–60%. Many studies demonstrated the various factors that influencethe yield of TBLB, including size, location, and distance from the carina or pleura. However, no study has evaluated theeffects of the bronchoscope diameter. We evaluated whether the bronchoscope diameter affected the diagnostic yield ofTBLB. Methods: We reviewed records from 178 patients who underwent TBLB using bronchoscopes of two different diameters(5.7 mm, thick outer diameter, Olympus BF-200; 4.9 mm, thin, BF-260). The fluoroscopic guidance rates, yield of TBLBand flexible bronchoscopy (FB) were compared between the two groups. Additionally, we compared the results of theprocedures with respect to diagnosis, distance from the pleura, and size of the lesion. Results: The results of fluoroscopic guidance, TBLB, and FB yield using thin diameter bronchoscope were significantlybetter than those obtained with a thick diameter bronchoscope (p=0.021, p=0.036, and p=0.010, respectively). Particularly,when the distance from the pleura was ≤ 10 mm, success rates for fluoroscopic guidance and FB with thin bronchoscopewere higher (p=0.013 and p=0.033, respectively), as compared to with thick bronchoscope. Conclusion: A thinner diameter bronchoscope increased the yield of bronchoscopy, and bronchial washing inconjunction with TBLB was useful in the diagnosis of peripheral pulmonary nodules.
Anaplastic lymphoma kinase (ALK) rearrangement, is a kind of driver mutation, accounts for 3%−5% of non-small celllung cancer (NSCLC). NSCLC patients harboring ALK fusion genes have distinct clinical features and good responseto ALK inhibitors. Metastasis from lung cancer to the ovary has rarely been known. We report a case of a 54-year-oldwoman with bilateral ovarian metastases from ALK rearranged NSCLC. She underwent bilateral salpingo-oophorectomyfor ovary masses, which were progressed after cytotoxic chemotherapy although primary lung mass was decreased. Histopathological examination of the ovary tumor showed characteristic adenocarcinoma patterns of the lung and ALKrearrangement.
The combination chemotherapy of irinotecan with 5-fluorouracil and leucovorin (FOLFIRI regimen) was recentlyproven to be beneficial in patients with advanced colorectal cancer. Pulmonary toxicity is very rare in adverse effects ofirinotecan. No case of organizing pneumonia (also known as bronchiolitis obliterans organizing pneumonia) associatedwith FOLFIRI chemotherapy has been reported. We experienced a case of a 62-year-old man who presented persistentdry cough and progressive dyspnea after receiving chemotherapy with FOLFIRI regimen. After surgical lung biopsy, thepatient was diagnosed with FOLFIRI chemotherapy-induced organizing pneumonia which was successfully treated withsteroid therapy.
Recently, the incidence of pulmonary cryptococcosis is gradually increasing in rheumatoid arthritis (RA) patients. Pulmonary rheumatoid nodules (PRN) are rare manifestations of RA. Eighteen months ago, a 65-year old woman was admitted to hospital due to multiple nodules (2.5×2.1×2 cm) with cavitations in the right lower lobe. She was diagnosed with RA three year ago. She had been taking methotrexate, leflunomide, and triamcinolone. A video-assisted thoracoscopic surgery biopsy was performed and PRN was diagnosed. However, a newly growing huge opacity with cavitation was detected in the same site. Pulmonary cryptococcal infection was diagnosed through a transthoraciccomputed tomograpy guided needle biopsy. Cryptococcus antigen was detected in serum but not in cerebrospinal fluid. The patient was treated with oral fluconazole which resulted clinical improvement and regression of the nodule on a series of radiography. Herein, we report the case of pulmonary cryptococcosis occurring in the same location as that of the PRN.
Disease flare-up after discontinuing epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) has beenconsidered as a critical issue in lung cancer patients who have experienced radiologic progression after showing initialdurable response. This is a case of systemic nocardiosis that occurred after chronic steroid use for radionecrosis from stereotactic radiosurgery. It was initially thought as a disease flare-up after stopping EGFR-TKI.
Antiphospholipid syndrome (APS) is an acquired systemic autoimmune disorder characterized by a combination of clinical criteria, including vascular thrombosis or pregnancy morbidity and elevated antiphospholipid antibody titers. It is one of the causes of deep vein thrombosis and pulmonary embolism that can be critical due to the mortality risk. Overall recurrence of thromboembolism is very low with adequate anticoagulation prophylaxis. The most effective treatment to prevent recurrent thrombosis is long-term anticoagulation. We report on a 17-year-old male with APS, who manifested blue toe syndrome, deep vein thrombosis, pulmonary thromboembolism, and cerebral infarction despite adequate longterm anticoagulation therapy.