Beyond the existing scope of asthma treatment, a number of biologics have recently been developed based on the immunopathological mechanism of severe asthma. Severe asthma has a wide variety of phenotypes or endotypes, more than half of which are associated with eosinophils or type 2 inflammation. This paper introduces newly developed biologics and those that are under development for treatment of asthma. The most successful biologics developed to date are anti-IgE and anti-interleukin (IL)-5 antibodies, followed by anti-IL-4, anti-IL-13, anti-prostaglandin D2 type 2 receptor, and anti-thymic stromal lymphopoietin antibodies. However, further studies on drugs that target type 1 inflammation are required.
Antibodies ; Asthma* ; Biological Products ; Biological Therapy ; Eosinophils ; Inflammation ; Phenotype ; Status Asthmaticus

Although guideline-based asthma therapy has had a positive impact on fatalities due to asthma over the last few decades, some patients refractory to or noncompliant with asthma treatment remain at risk of fatality. A 45-year-old female with refractory asthma and poor compliance and with a frequent history of hospitalization for asthma exacerbations was taken to the emergency room because of cardiorespiratory arrest. Her family reported that she had suffered from an upper respiratory infection followed by severe dyspnea for a few days. The patient developed status asthmaticus, and in spite of intensive cardiopulmonary resuscitation, she was eventually declared brain dead. The patient had not taken medication for asthma regularly for several months before the attack. Refractory and difficult-to-treat asthma should be aggressively monitored to prevent severe asthma exacerbations, which can be fatal, especially in noncompliant patients.
Asthma ; Brain ; Brain Death ; Cardiopulmonary Resuscitation ; Compliance ; Dyspnea ; Emergencies ; Female ; Hospitalization ; Humans ; Middle Aged ; Status Asthmaticus

Status asthmaticus is a rare, fatal condition, especially in children. Sometimes respiratory support is insufficient with a mechanical ventilator or medical therapy for patients with status asthmaticus. In such situations, early extracorporeal membrane oxygenation application is a useful method for treating refractory respiratory failure. We report on a case of a six-year-old, male child who underwent venovenous extracorporeal membrane oxygenation support for refractory status asthmaticus.
Asthma ; Child ; Extracorporeal Circulation ; Extracorporeal Membrane Oxygenation ; Humans ; Male ; Respiratory Insufficiency ; Status Asthmaticus ; Ventilators, Mechanical

We report a case of severe status asthmaticus in a 3-year-old boy who required mechanical ventilatory support. He initially presented with rapidly progressing respiratory distress and spontaneous air leaks. Although he was intubated and received mechanical ventilation, dynamic hyperinflation and air leaks were aggravated. We applied the volume control mode, providing sufficient tidal volume (10 ml/kg), a reduced respiratory rate (25/minute), and a prolonged expiratory time (1.8 seconds) to overcome dynamic hyperinflation. After allowing full expiration of trapped air, his over-expanded lung volumes were decreased and the air leaks resolved. He made a complete recovery without sequelae. Dynamic hyperinflation in asthmatic patients occurs from incomplete exhalation throughout narrowed airways. Controlled hypoventilation or permissive hypercapnia is an important lung-protective ventilator strategy and is beneficial in reducing dynamic hyperinflation. We suggest a controlled hypoventilation strategy with a prolonged expiratory time for patients in severe status asthmaticus with dynamic hyperinflation.
Asthma ; Exhalation ; Humans ; Hypercapnia ; Hypoventilation ; Lung ; Positive-Pressure Respiration, Intrinsic ; Preschool Child ; Respiration, Artificial ; Respiratory Rate ; Status Asthmaticus ; Tidal Volume ; Ventilators, Mechanical

Pseudoaneurysm formation in the pulmonary vasculature is a rare but fatal condition. Several etiologies have been described including trauma, complication after cardiac or other surgeries, tuberculosis, necrotizing pneumonia, congestive heart disease, atherosclerosis, cancer and vasculitis. We report a case of pseudoaneurysm found in a patient being treated with status asthmaticus, who developed complications of pneumonia and brain abscess secondary to sepsis.
Aneurysm, False ; Atherosclerosis ; Brain Abscess ; Estrogens, Conjugated (USP) ; Heart Diseases ; Humans ; Pneumonia ; Sepsis ; Status Asthmaticus ; Tuberculosis ; Vasculitis

GC is wonderful drug to prevent and control bronchial asthma. Methods: 1026 inpatients with asthma presented at the Department of Allergy and Clinical Immunology were included in this study. Cross - sectional surveys and retrospective studies. Objectives: Study on situation of using GC of asthmatic patients. Describe adverse drug reactions of glucocorticoid to asthmatic in - patients at the Department of Allergy and Clinical Immunology. Results: All of 1026 patients used Gc. Prednisolon, solu - medrol, depersolon and pulmicort were most used medications. There were 295 asthmatic patients have side effects (28.75%) with 24 types of symptom, 15 diseases and syndromes are resulted: Cushing syndrome, gastric ulcer, diabetes, hypertension, ponosis, retarded development... Almost systemic organs of the patients were influenced negatively by Gc. It has relationship among the way to use, the time in used GC and adverse drug reactions of GC. Conclusions: GC caused many adverse drug reactions to asthmatic patients.
Asthma ; Status Asthmaticus ; Patients ; Glucocorticoids

Thymic carcinoid tumors are very rare and grow slowly with low grade of malignancy. It can manifest flushing, diarrhea, and bronchial constriction with secretion of serotonins, histamines or neuropeptides. We experienced a case of thymic carcinoid tumor, which aggravated asthma. A 59-year-old male had been in a well-controlled state, until he was admitted for status asthmaticus 2 years ago. Since then, he had suffered from frequent dyspnea and had severe asthma attack leading to ICU care twice in spite of full optimal anti-asthma therapy. Nine months ago, anterior mediastinal tumor was found incidentally, which was diagnosed as carcinoid tumor. After resection, his asthmatic symptoms and signs were improved and controlled in a persistent mild state. Taken together, this case indicates that asthma might be aggravated by carcinoid syndrome caused by thymic carcinoid tumors.
Asthma* ; Bronchoconstriction ; Carcinoid Tumor* ; Diarrhea ; Dyspnea ; Flushing ; Humans ; Male ; Middle Aged ; Neuropeptides ; Serotonin ; Status Asthmaticus ; Thymus Gland

BACKGROUND: MacFarlane and Rosenthal reported a case of acute quadriplegia after nondepolarizing muscular blocking agents in status asthmaticus patient treated with high doses of corticosteroid. Reports regarding the reactions of glucocorticoid treated muscles to neuromuscular blocking agents are sparse and inconsistent. The aims of this study were to examine the degree of muscle atrophy and its effects on sensitivity to neuromuscular blocking agents in relation to the dose and duration of dexamethasone. METHODS: Sixty Sprague-Dawley rats were divided into six groups. They were treated daily with dexamethasone 0.4 mg/kg and 4 mg/kg daily for 1 week or 3 weeks. The two control groups were treated with normal saline. The day after treatment, the dose-response curves of vecuronium were measured using a phrenic nerve-hemidiaphragm preparation. To classify muscle fiber, the diaphragm was stained for myofibrillar adenosine triphosphatase after alkaline and acid preincubation, and a morphometric examination was carried out. RESULTS: The diaphragmatic muscle in rats treated with long term, high dose dexamethasone showed significant atrophy. For the short term, low dose dexamethasone group, the ED50 and ED95 of vecuronium decreased 41.5% and 26.8% compared to those of the control group, respectively (P<0.05). However, the ED50 of vecuronium in the long term, high dose dexamethasone group increased 22.2% compared to that of the control group (P<0.05). CONCLUSION: This study suggests that sensitiviy to vecuronium was not modulated by dexamethasone-induced muscle atrophy. Quantitative changes of receptors at the neuromuscular junction or some anoother process might be responsible for this change.
Adenosine Triphosphatases ; Animals ; Atrophy ; Dexamethasone* ; Diaphragm ; Humans ; Muscles ; Muscular Atrophy ; Neuromuscular Blocking Agents ; Neuromuscular Junction ; Quadriplegia ; Rats* ; Rats, Sprague-Dawley ; Status Asthmaticus ; Vecuronium Bromide

Stevens-Johnson syndrome is considered to be a severe type of erythema exsudativum multiforme. It is characterized by erythema with vesicobullous and eroded lesions of skin and mucous membranes. The importance in anesthetic management of Stevens-Johnson syndrome is preventing injury of the oropharyngeal and tracheal membrane at intubation because soft oral airways may cause bleeding and push tissue debris into the pharynx and larynx. In addition, anesthesiologist should take care of complications such as transitory atrial fibrillation, interstitial myocarditis, pericarditis, pneumothrax, acute renal insufficiency and conjunctivitis. A 5-year-old male, previously diagnosed with Stevens-Johnson syndrome and treated with a steroid, was noted as having dyspnea on rest, coughing, jaundice, and fever. Even after aggressive medical management for status asthmaticus during the preoperative period, dyspnea and expiratory wheezing did not improve. He underwent a resection of the gall bladder, lung and liver biopsy in spite of a great risk of perioperative pulmonary complications. After treatment with epinephrine, and aminophylline, the peak inspiratory pressure was 40 cmH2O with mild hypercarbia (PaCO2 45 50 mmHg). We report the anesthetic considerations for a case of Steven-Johnson syndrome with status asthmaticus.
Acute Kidney Injury ; Aminophylline ; Atrial Fibrillation ; Biopsy ; Child, Preschool ; Conjunctivitis ; Cough ; Cytochrome P-450 CYP1A1 ; Dyspnea ; Epinephrine ; Erythema ; Fever ; Hemorrhage ; Humans ; Intubation ; Jaundice ; Larynx ; Liver ; Lung ; Male ; Membranes ; Mucous Membrane ; Myocarditis ; Pericarditis ; Pharynx ; Preoperative Period ; Respiratory Sounds ; Skin ; Status Asthmaticus* ; Stevens-Johnson Syndrome* ; Urinary Bladder

Acute Disease ; Decision Making ; Disease Progression ; Emergency Service, Hospital ; Humans ; Prognosis ; Respiration, Artificial ; Status Asthmaticus ; therapy ; Time Factors