Predicting outcomes of oral aspirin challengesin patients with asthma, nasal polyps, andchronic sinusitis
ABSTRACT A definitive diagnosis of aspirin-exacerbated respiratory disease (AERD) requires a positive oral aspirin challenge (OAC), but predicting which patients will have positive challenges is often difficult.
To analyze information about historical aspirin- and nonsteroidal anti-inflammatory drug (NSAID)-associated respiratory reactions and clinical characteristics as potential markers to predict positive OACs.
A total of 243 patients underwent OACs. Data related to previous reactions and clinical characteristics of patients were correlated with the result of the OACs.
Without prior exposure to aspirin or NSAIDs, the chance of a positive OAC was 5 in 12 (42%) but was 198 in 231 (86%) for those with a history of aspirin- and NSAID-associated asthma attacks. Sex, atopy, number of sinus infections per year, and number of sinus surgical procedures were not associated with positive OACs. Patients with 2 or more prior aspirin- and NSAID-associated respiratory reactions had an 89% chance of having a positive OAC vs single reactors (80%; P = .04). Mild or moderate prior reactions were associated with 84% or 80% positive OACs, whereas 100% of the 45 patients with severe prior reactions had positive OACs (P = .007). Except for hospitalizations, treatment locations of prior reactions (home or emergency department) did not seem to make any difference. Logistic regression identified age, sense of smell, and multiple prior reactions as independent risk factors associated with positive OACs.
Age younger than 40 years, poor sense of smell, multiple prior respiratory reactions, and severe prior asthmatic reactions associated with aspirin and NSAIDs significantly increased the chances of a positive OAC.
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ABSTRACT: The medications used in asthma have been the subject of intense study over the last three decades. We now have extensive insights into their structure, regulation, receptors and mechanisms of action. Their intersection with the complexity of asthma inflammation has also been well characterised. In parallel, good quality pharmaceutical trials have informed national guidelines and patient-centered outcomes have been explored. With this therapeutic armamentarium the practitioner should aim to achieve the goals of asthma therapy that are focused on clinical and lung function parameters. The concept of complete asthma control is the current benchmark. Airway inflammation is the fundamental problem in asthma and, logically, anti-inflammatory therapy in the form of inhaled corti-costeroids is the single most important intervention. The importance of appropriate use of inhaler devices cannot be sufficiently emphasised. The clinician carefully titrates this treatment utilising additional medications for synergy and to modulate side-effects and costs. The contemporary standard of asthma care is a single inhaler with a combination of inhaled corticosteroids (ICS) and long-acting beta adrenoceptor agonists. The alternative is to add leukotriene modifiers to ICS therapy; there are special circumstances when this may be more appropriate. Poor inhaler use and concomitant allergic rhinitis are examples when supplementation with anti-leukotriene agents would be prudent. With whatever therapeutic strategy, regular education of the patient, tailoring of medication and monitoring of asthma are still crucial to ensure that the goals of asthma control are achieved and maintained in the long term.Official journal of the South African Academy of Family Practice/Primary Care 08/2014; 50(4). DOI:10.1080/20786204.2008.10873735
Article: [Drug allergy].Nippon rinsho. Japanese journal of clinical medicine 02/1993; 51 Suppl:630-42.
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ABSTRACT: An improved triaxial cell for measuring the transfer impedance of the shields of multipins backplane connectors has been developed. Much attention has been paid to the design of the outer and inner transmission line of the test cell. In particular the excitation of the connector and the connection of the connector shield to the inner conductor of the test cell have been optimised which allows determination of the transfer impedance up to 3 GHz. Various connector configurations have been compared, showing a large influence of the signal pin location in the connector and of the connector shieldsElectromagnetic Compatibility, 1997. IEEE 1997 International Symposium on; 09/1997