Immunology of the Lung - Nature video



From the Nature Immunology: http://www.nature.com/ni/index.html -- Our lungs bring in vital oxygen and expel carbon dioxide. But they’re also an important immune site. They filter the air we breathe, repulsing invaders and repairing injury. But sometimes these powerful immune responses overreact, causing diseases such as asthma.

Should all patients with severe asthma get tested for AAT deficiency?


α1-Antitrypsin (A1AT). Image source: Wikipedia, GNU Free Documentation License.

There is an uncertain relationship between severe AAT deficiency and asthma. Studies have not shown an increased prevalence of AAT deficiency among asthmatics. There is no association of alpha-1 antitrypsin Pi variants such as Pi MZ or Pi MS with more severe asthma.

However, in a large cohort study of over 1000 patients with severe AAT deficiency, 21% of patients had asthma. The presence of asthma was not independently associated with an accelerated decline in pulmonary function, and the results of augmentation therapy appear to be similar for asthmatics and nonasthmatic patients with severe AAT deficiency.

Should patients with severe asthma get tested for AAT deficiency?

For some patients, yes. For the lifelong non-smoker with persistent and irreversible airflow obstruction, a one-time measurement of the serum alpha-1 antitrypsin level is recommended to exclude emphysema due to homozygous alpha-1 antitrypsin deficiency, which is in the differential of chronic and largely irreversible airflow limitation.

References:

Evaluation of severe asthma in adolescents and adults. UpToDate, 2014.
Diagnosis of asthma in adolescents and adults. UpToDate, 2014.
Eden E, Hammel J, Rouhani FN, et al. Asthma features in severe alpha1-antitrypsin deficiency: experience of the National Heart, Lung, and Blood Institute Registry. Chest 2003; 123:765.
http://www.ncbi.nlm.nih.gov/pubmed?term=12628876

What is the word origin of allergy and asthma conditions?

Google dictionary card has etymological information, a translation box and a graph that shows the use of a word over time. If you only want to find the origin of a word like "allergy", you don't have to search for [define allergy]. You can search for [allergy origin] or [allergy word origin] and Google shows a special version of the dictionary card that highlights etymological information. Google Search Card results for "Word Origin" for common allergy and asthma conditions are shown below. You can see them all in the slideshow, or click through the links:

allergy
asthma
urticaria
anaphylaxis
dermatitis
atopic



allergy



asthma



References:

Word Origin Google Search Card http://bit.ly/1CqBXfr
Google Updates the Dictionary OneBox http://bit.ly/1CqBYjI

Top Asthma Articles for January 2015

Here are my suggestions for some of the top articles about asthma published recently:

Asthma and Allergen Sensitization start earlier in life than previolsy reported (age 2 for asthma, age 1 for allergy), dust mite is the culprit in 80% http://buff.ly/1uU6P5u

Exercise-induced bronchoconstriction (EIB) underdiagnosis may result in habitual avoidance of sports and physical activity, chronic deconditioning, weight gain, poor asthma control, low self-esteem, and reduced quality of life. Improving EIB diagnosis: no existing EIB screening questionnaire had adequate sensitivity and specificity http://buff.ly/1k1KEFT

Vitamin D supplementation in adults with asthma is not indicated - VIDA RCT http://buff.ly/1hZ1KzT

Humanized monoclonal antibody (AMG 157) against a novel target in human asthma, thymic stromal lymphopoietin (TSLP) http://buff.ly/1knrvON

Irritant-induced (occupational) asthma (IIA) - EAACI position paper http://buff.ly/1omacyu

Climate change and respiratory diseases http://buff.ly/1k8txiB (free full text)

Childhood asthma phenotypes in the twenty-first century http://buff.ly/1k8tHX5 (free full text)

The role of macrolides in asthma - The Lancet Respiratory Medicine http://buff.ly/1lRmbUC (free full text after registration)

Quilizumab: New Inhaled Drug Shows Promise Against Asthma, Allergies http://buff.ly/1mXuLSF

Thiazolidinediones may provide a new anti-inflammatory approach to asthma http://buff.ly/1r14W4x

Revisiting an Old Therapy: Theophylline in Asthma http://buff.ly/1r1aXhI

Omalizumab may have anti-inflammatory effects on small airways and reverse airway remodeling http://buff.ly/1r1bccG

Impact of azithromycin therapy on airway microbiota in asthma: decreased bacterial richness, Anaerococcus dominant http://buff.ly/1vOM5df

Survey of 8,000 asthma patients: poor control in 45%, yet most regarded their asthma as not serious and controlled http://buff.ly/1qLVDaX

EHR–Generated Interventions to Reduce Asthma Risk: Seeing the Glass Half Full http://buff.ly/1yrkphB

Children treated daily with ICS grow 0.5 cm less during the first year of treatment, no difference second year http://buff.ly/1jSwb1f

Nebulizers are everywhere, despite years of research showing that MDIs are equivalent with lower cost/side effects http://buff.ly/Uoefj6

In elderly asthmatics, vitamin D supplementation for 12 weeks improved ACT scores http://www.aacijournal.com/content/10/1/48



Severe asthma: “What to do when asthma is not doing well?” (click to enlarge the image).

The articles were selected from Twitter @Allergy and RSS subscriptions. Some of the top allergy accounts on Twitter contributed links. I appreciate the curation provided by @Aller_MD @IgECPD @DrAnneEllis @mrathkopf @MatthewBowdish.

Please feel free to send suggestions for articles to AllergyGoAway AT gmail DOT com and you will receive an acknowledgement in the next edition of this publication.

Using the Ellipta Inhaler Device - training video from National Jewish Health

Get step-by-step instructions for how to use the Ellipta inhaler, a device containing medication to treat COPD and asthma.


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