A 31-year-old pregnant woman with angioedema.

Angioedema is swelling of the deep layers of the dermis and subcutaneous tissue due to an increase in vascular permeability. Angioedema sometimes occurs concomitantly with urticaria and represents an allergic disease. In other cases, angioedema is not associated with an allergic condition. We present the case of a 31-year-old woman with new-onset angioedema in the setting of her first pregnancy. After detailed history, physical examination, and laboratory evaluation, a cause for her angioedema was found that had not been considered previously and had significant implications for future management, particularly in light of her current pregnancy. Because allergists are commonly called on to evaluate and treat angioedema, we should be aware of the many disease processes that can present with this symptom and be well-versed in the workup of new-onset angioedema.

Young, African American adults with asthma: what matters to them?

BACKGROUND: Asthma is a common chronic condition that shows significant health disparities among minority populations. Little research has focused on the management needs and preferences of young African American adults with asthma, a population undergoing dramatic life changes as they transition from adolescence to adulthood. OBJECTIVE: To understand the experiences and perspectives of young African American adults managing their asthma. METHODS: Focus groups were conducted with African American adults (n = 34) 18 to 30 years old with a physician diagnosis of asthma. Focus group sessions were audiotaped, transcribed verbatim, and coded using constant comparative analysis. RESULTS: Six major domains were identified and some of the salient themes included changes in asthma management needs with the onset of adulthood, career limitations owing to asthma, childcare interference with asthma regimen adherence, and difficulties with medication cost owing to lapses in insurance coverage. Participants also reported feeling discouraged when interacting with physicians as it related to their asthma care; yet ageism and racism were not perceived. Despite poor medication regimen compliance, participants were overwhelmingly interested in participating in asthma self-management programs and had strong preferences that such programs be tailored specifically to young adults with special consideration of the cultural experience of young African Americans with asthma. CONCLUSION: Young African American adults have specific barriers to optimal asthma care and distinctive ideas for self-management programs. It is important for the asthma care provider to identify and address these population- and age-specific barriers to improve asthma outcomes and decrease health care disparities.

Anosmia and an uncommon nonsteroidal anti-inflammatory drug reaction in a 38-year-old man.

Anosmia with asthma and nasal polyposis raises suspicion for aspirin-exacerbated respiratory disease (AERD). Guidelines for desensitization of patients with AERD to prevent recurrent nasal polyposis and improve upper and lower respiratory symptoms are well established. We present a patient with an uncommon reaction to acetylsalicylic acid (ASA) and nonsteroidal anti-inflammatory drugs who required deviation from the standard ASA desensitization approach.

An Electronic Asthma Self-Management Intervention for Young African American Adults.

BACKGROUND: Health disparities are seen in many chronic conditions including asthma. Young African American adults represent a population at high risk for poor asthma outcomes due to both their minority status and the difficult transition from adolescence to adulthood. Recruitment and retention has been challenging in this demographic stratum, and traditional asthma education is often not feasible. OBJECTIVE: The objective of this study was to develop and assess the feasibility of an electronic asthma self-management program for young African American adults. METHODS: A total of 44 African American adults (age 18-30 years) with uncontrolled persistent asthma were enrolled in an asthma self-management program. The 6-week Breathe Michigan program (predicated on the social cognitive theory) was tailored specifically to the concerns and preferences of young African American adults. The entire program was completed electronically, without any specialized human support. At 2 weeks and 3 months after program completion, participants were contacted for follow-up. RESULTS: A total of 89% of enrolled subjects completed the 6-week intervention, and 77% were available for evaluation at 3 months. All subjects completing the 2-week postprogram survey reported that the program was helpful, and 97% would recommend it to others. Asthma control as measured by the Asthma Control Test improved from 16.1 to 19.3 (P < .01), and asthma quality of life as measured by the Mini Asthma Quality of Life Questionnaire improved from 4.0 to 5.1 (P < .01). CONCLUSIONS: The Breathe Michigan program is feasible for recruitment and retention, and demonstrated an improvement in asthma control and quality of life for young African American adults.