Background:Asthma represents one of the most common medical conditions encountered during pregnancy, which may seriously affect its outcome. Objective: To evaluate the outcome of asthma attacks during pregnancy and the role medications play for appropriate asthma management. Methods: In this prospective study, we present our 15 years’ experience from hospitalization in ICU of 11 pregnant women (13-29 weeks of gestation) with severe asthma.

Tracheo-bronchial amyloidosis is a rare airway disorder that can be a challenge for the limitations of treatment, recurrence and complications. We report the complex clinical course of a patient with symptomatic localized tracheo-bronchial amyloidosis. Different procedures were performed due to recurrent amyloid over a period of three and half years from the first endoscopic resection

A multidisciplinary team approach to diagnosis and management of interstitial lung diseases (ILD) is considered gold standard and an integral part of ILD management and guidelines.The accurate diagnosis and management of individuals with ILDs poses an interesting challenge in clinical practice. This is a single center retrospective review of electronic patient letters and multidisciplinary team (MDT) records spanning a five and half year time period. In this study we assessed the accuracy of prior ILD diagnosis, the methodology used to establish a correct diagnosis and how an MDT approach to diagnosis affected subsequent management.

The current National Institute for Health and Care Excellence (NICE) chronic obstructive pulmonary disease (COPD) guidelines were updated in 2010, reflecting clinical evidence available at that time. Since the guidelines were written, a growing body of evidence has demonstrated enhanced Bronchodilation with LABA/LAMA in fixed-dose combinations (FDCs) versus single component agents (the standard of care) in moderate to severe COPD. Studies to date indicate that the indacaterol/glycopyrronium (QVA149) and umeclinidium/vilanterol (UMEC/VI) can optimize Bronchodilation and may lead to improvements in patient-reported outcomes beyond lung function. The evidence for LABA/LAMA FDC, in particular glycopyrronium/indacaterol, and also umeclidinium/vilanterol, supported by meta-analysis, shows that dual Bronchodilation provides superior efficacy compared with LAMA monotherapy (glycopyrronium or tiotropium), and suggests the appropriateness of progression to LABA/LAMA combinations after LAMA mono therapy rather than escalation to LABA/ICS in patients with persistent breathlessness. The debate regarding the benefits and risks of LABA/ICS is on-going, with data now more firmly showing an association with inhaled ICS use and pneumonia. In patients with moderate or severe airflow obstruction and no history of exacerbations in the past year, randomised data showed that glycopyrronium/indacaterol was superior to LABA/ICS in improving lung function and breathlessness score. How to quantify the benefits of LABA/LAMA FDC over Mono therapy will be an ongoing debate, and consideration of other parameters such as a responder analysis of the proportion of patients that did achieve a threshold, may be better suited to establish clinically relevant differences between active agents and placebo. This review highlights the need to consider revisions to the current NICE COPD guidelines to reflect the recently published evidence demonstrating a role for LABA/LAMA FDC in the treatment of moderate to severe COPD

People ascending to high altitude regions are at risk for a variety of health problems, commonly including acute mountain sickness (AMS), high-altitude cerebral oedema (HACE) and high-altitude pulmonary oedema (HAPE) etc. Increasing travel to mountainous terrains has brought light to several other medical problems as well. It has been well recognized that a hypercoagulable state exists when a person is exposed to high altitude environment. This may manifest as early thromboembolic episodes, which may result in deep vein thrombosis (DVT) or acute pulmonary embolism (PE), which is a potentially fatal condition. The various effects of thrombosis include pulmonary thrombo-embolism (PTE), cerebral venous thrombosis, portal/splenic vein thrombosis, and deep vein thrombosis (DVT). Out of all these conditions, PTE is an extremely common and highly lethal condition that is a leading cause of death in all age groups. Exposure to high altitude (HA), either during air travels, ascension of mountains, or while engaging in sports activities results in hyper coagulability thus predisposing to thromboembolic events. Climbers staying at high altitudes for weeks also possess several risk factors for thromboembolism. A large number of environmental variables suggest that a single cause of HA-induced thromboembolic disorders (TED) may not exist, so that this peculiar phenomenon could be seen as a complex or multifactorial trait. In view of the greatly increased risk of getting deep venous thrombosis and pulmonary embolism at high altitude, it would be interesting to review the studies done so far for defining its cause and treatment. Thus the present review examines the risk of thrombosis at increasing elevations along with the possible underlying mechanisms, the diagnosis and treatment strategies.

Background: Primary ciliary dyskinesia (PCD) is a genetic disease characterized by abnormally beating cilia. In these patients levels of nasal nitric oxide (nNO) are lower than those observed in healthy subjects. Objectives: We recorded the nNO levels in PCD patients in order to use those nNO measurements in the screening and identification of patients with symptoms suggestive of disease PCD disease.