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Biomedical subjects

Miles Weinberger

Publications and source records attributed to Miles Weinberger.

At least 19 recordsLinked to original sources
PubMed2006

Shrinking lung syndrome in a 14-year-old boy with systemic lupus erythematosus.

Pulmonary complications occur frequently in people with systemic lupus erythematosus. We report on an adolescent with an acute onset of dyspnea and pleuritic chest pain with severe restrictive lung physiology on pulmonary function testing (forced vital capacity, 20% of predicted) who had no evidence of parenchymal lung or pleural disease. He was found to have restricted diaphragmatic movement as assessed by fluoroscopy, without evidence of generalized respiratory muscle weakness. His clinical presentation and results of diagnostic tests were typical for shrinking lung syndrome. Given the rarity of shrinking lung syndrome in the pediatric age range, many clinicians are not aware of it as a clinical entity. Shrinking lung syndrome should be included in the differential diagnosis of dyspnea in both children and adults with systemic lupus erythematosus.

Adolescent↗
PubMed2005

Exercise-induced dyspnea in children and adolescents: if not asthma then what?

BACKGROUND: Exercise-induced dyspnea (EID) in children and adolescents is a common manifestation of asthma and is therefore commonly attributed to exercise-induced asthma (EIA) when present in otherwise healthy children. OBJECTIVE: To report the outcome of evaluations for EID when other symptoms and signs of asthma were absent or if there was no response to previous use of an inhaled beta2-agonist. METHODS: We reviewed the results of all exercise tests performed in otherwise healthy patients with EID during 1996 to 2003. Physiologic measures included preexercise and postexercise spirometry with the addition of oxygen uptake, carbon dioxide production, continuous oximetry, and electrocardiogram monitoring during most tests. EIA was diagnosed if symptoms were reproduced in association with a 15% or greater decrease in forced expiratory volume in 1 second from baseline. Endoscopy was performed if stridor and/or decreased maximal inspiratory flow were present. Criteria were established for restrictive abnormalities, physical conditioning, exercise-induced hyperventilation, and normal physiologic limitation. RESULTS: A total of 142 patients met our criteria for inclusion. EID had been present in these patients for a mean duration of 30.2 months (range, <1 to 192 months) before evaluation and had been previously attributed to asthma by the referring physician in 98 of them. Symptoms of EID were reproduced during exercise testing in 117 patients. EIA was identified as the cause of EID in only 11 of those 117. Seventy-four demonstrated only normal physiologic exercise limitation; 48 of these 74 had normal to high cardiovascular conditioning, and 26 had poor conditioning. Other diagnoses associated with reproduced EID included restrictive abnormalities in 15, vocal cord dysfunction in 13, laryngomalacia in 2 (1 of whom had unilateral vocal cord paralysis), primary hyperventilation in 1, and supraventricular tachycardia in 1. CONCLUSION: The diagnosis of EIA should be questioned as the etiology of EID in children and adolescents who have no other clinical manifestations of asthma and who do not respond to pretreatment with a beta2-agonist. Exercise testing that reproduces symptoms while monitoring cardiac and respiratory physiology is then indicated to identify causes of EID other than EIA.

Administration, Inhalation↗
PubMed2004

Respiratory infections and asthma: current treatment strategies.

Infections such as lower respiratory illness potentially contribute to the initiation of asthma and are major factors in recurring acute exacerbations of the condition. Although typical bacterial respiratory pathogens such as Streptococcus pyogenes, Streptococcus pneumoniae and Hemophilus influenzae do not initiate asthmatic exacerbations, data from a subgroup of adults suggest a potential role for Mycoplasma pneumoniae and Chlamydia pneumoniae in the onset of asthma. Common cold viruses, predominantly respiratory syncytial virus (RSV) in young children and rhinoviruses in older children and adults, are the major causes of acute exacerbations of asthma. These exacerbations are not prevented with maintenance therapies that are used for chronic asthma, but do respond to short courses of systemic corticosteroids. There are continued attempts to produce a successful vaccine and antiviral agents for the treatment of RSV that are more effective and more practical to use than ribavirin, which is currently the only available antiviral for RSV. The prevention and treatment of rhinovirus infections have focused on the major receptor for the virus, intercellular adhesion molecule-1 (ICAM-1), which is located on respiratory epithelial cells. A multivalent, recombinant, antibody fusion protein identified as CFY196 has high avidity for ICAM-1 and has the potential to protect against rhinovirus infection. Another approach for preventing and treating rhinovirus infection uses a recombinant, soluble, truncated form of ICAM-1 in which the transmembrane and intracellular domains of the protein have been deleted. An initial clinical study on this agent demonstrated clinical efficacy in ameliorating the symptoms of experimental rhinovirus infection in volunteers, but did not significantly prevent infection.

Acute Disease↗
PubMed2003

Levalbuterol.

Explore the source record for details and available documents.

Adrenergic beta-Agonists↗
PubMed2003

Clinical patterns and natural history of asthma.

Childhood asthma typically begins in infancy with a respiratory syncytial virus (RSV) infection. Although the majority of infants become infected with RSV, lower respiratory illness develops in only about 20%. About 25% to 50% of those subsequently experience recurrent acute asthma from viral respiratory infections (VRI). Children younger than 5 years have a high frequency of VRI and have the highest frequency of hospitalization for asthma of any age group. In a 35-year study of the natural history of asthma, 20% of 7-year-old children were found to have asthma, but most had only episodic illness with VRI. The majority of those children improved with age, but a substantial minority continued to have recurrent episodes as adults, generally induced by VRI or exercise. Persistent asthma developed in only a few. Children who had symptoms of asthma without VRI were more likely to continue having frequent episodic or chronic asthma as adults. Despite generally suboptimal treatment during the 35 years of the study, forced expiratory volume at one second did not deteriorate over time; it remained normal in children who had only episodic asthma, and it was consistently low in the children with severe, persistent asthma.

Adult↗
PubMed2003

Treatment strategies for viral respiratory infection-induced asthma.

The many therapeutic options for asthma can confuse both physicians and patients. Great emphasis has been placed on maintenance medication, particularly inhaled corticosteroids (ICS), which are the most effective medication for patients with persistent symptoms. However, asthma in young children is most commonly intermittent, triggered almost exclusively by viral respiratory infections (VRI). It is, nevertheless, associated with the highest rate of hospitalization of any age. Conventional doses of ICS do not prevent exacerbations of VRI-induced asthma. In contrast, intervention with oral corticosteroids during exacerbations has been shown to prevent the progression that would otherwise require urgent care or hospitalization. An oral corticosteroid kept on hand by the patient permits initiation of more prompt and effective treatment than is likely to occur when a patient must first go to a physician's office or emergency department, because it can be given as soon as the response to bronchodilator therapy is incomplete. Monitoring by phone and regularly scheduled physician visits to review the clinical course and reinforce education can then replace urgent medical care, thereby improving the quality and efficacy of asthma management.

Acute Disease↗