Prevalence of asthma and asthma-like symptoms in Dalat Highlands, Vietnam.

INTRODUCTION: No data has been reported on the prevalence of asthma in highland rural areas of Vietnam. We attempt to determine the prevalence of asthma and asthma-like symptoms in Dalat, a Vietnamese city at 1,500 m altitude, and to learn about environmental influences, patient attitudes toward diagnosis and treatment, and the prevalent general knowledge about asthma. METHODS: Investigators were trained in the use of formal questionnaires. After an extensive publicity campaign by local television, the investigators randomly selected homes for interviews in 12 districts. When physician-diagnosed asthma or asthma-like symptoms were identified, all parts of the questionnaire were completed and a more detailed visit was arranged with the patients, for clinical examination, spirometry and skin tests for important allergens. RESULTS: 9,984 individuals were interviewed, of whom 243 were identified as having asthma or asthma-like symptoms, giving a prevalence of 2.4 percent. Average age was 48 +/- 27 years, age at onset of asthma was 25 +/- 22 years. Hospitalisation had been required in 18.3 percent of patients during 2003. Daily asthma treatment was used by only 17 percent of patients. 34 percent used inhalers and 6 percent used nebulisation. 52.3 percent had associated atopic features. Polyvalent positive prick tests were prevalent, but no one reacted to a pollen mixture. General knowledge about asthma was lacking. CONCLUSION: The prevalence of asthma and asthma-like symptoms in Dalat is low. Allergic cutaneous reactions to house mites predominate. Diagnosis and treatment of those afflicted with asthma appears to be suboptimal. The study highlights the need for further patient education and for preventative interventions for asthma sufferers in this region.

Thoracoscopic talc poudrage in malignant pleural effusions: effective pleurodesis despite low pleural pH.

STUDY OBJECTIVE: To determine the effectiveness of pleurodesis by thoracoscopic talc poudrage (TTP) in patients with low pH malignant pleural effusions. DESIGN: Review of prospectively collected data on all thoracoscopic procedures performed from 1982 to 1996. PATIENTS AND SETTING: Twenty-five members in a prepaid, closed-panel health maintenance organization, whose malignant pleural effusion pH was < or = 7.30. INTERVENTIONS: Pleural fluid pH was measured prior to diagnostic and therapeutic, single puncture, rigid thoracoscopy, under local anesthesia, in an operating room. MEASUREMENTS AND RESULTS: Success of pleurodesis was determined with serial radiographs at 10 days, 30 days, and frequent intervals until death or up to 1 year following the procedure. Failure was indicated by evidence of recurrent fluid or persistence of a space between the visceral and parietal pleura. Morbidity of the procedure, days of chest tube drainage, and days of hospitalization were recorded concurrently during hospitalization and outpatient follow-up. Fifty of the 76 patients found to have a pleural pH measurement had a pleural pH >7.30, averaging 7.37 (7.31 to 7.55). The other 26 patients (34%) with pH < or = 7.30 (low pH) are the subjects of this study, of whom 25 were evaluable. Pleurodesis was successful in 22 of 25 (88%), although 4 died prior to 30 days. The three failures all had trapped lung. Chest tube drainage averaged 3.2+/-1.3 days, which approximated the time of hospitalization (3.3+/-1.1 days). There were no thoracoscopy-related deaths; significant morbidity occurred only in one patient with trapped lung, who had prolonged chest tube drainage before and after TTP, and eventually developed empyema. CONCLUSIONS: TTP is an effective pleurodesis technique in malignant pleural effusions, even when the pleural pH is low. The short hospital stay and high success rate make this approach a good choice in palliating symptomatic malignant pleural effusions.

Thoracoscopic talc poudrage pleurodesis for chronic recurrent pleural effusions.

OBJECTIVE: To assess the effectiveness of thoracoscopic talc poudrage for the treatment of chronic pleural effusions. DESIGN: Prospective evaluation. SETTING: Kaiser-Permanente Hospital. PATIENTS: Forty-seven consecutive patients with recalcitrant pleural effusions, referred for thoracoscopy. INTERVENTION: Patients received general or local anesthesia; 42 had a 7-mm rigid thoracoscopic examination followed by insufflation of 5 mL of talc. Patients then had chest-tube drainage. MEASUREMENTS: We recorded clinical characteristics, final diagnosis, procedure-related pain and morbidity, days of hospitalization, patient-reported degree of symptom relief, and chest roentgenographic results at 1, 3, and 12 months. All patients were followed for 16 months or until death. MAIN RESULTS: Of 39 evaluable patients, all reported prolonged relief of effusion-related dyspnea. Radiographic results confirmed the elimination of pleural effusions in 34 patients (87%), including all 11 with benign conditions and 23 of 28 (82%) with malignancies. Treatment failed in three patients because of entrapped lung and in two patients with mesotheliomas whose effusions recurred more than a year after treatment. No procedure-related mortality or morbidity was found. Ambulatory patients required hospitalization for a mean of 3.9 days (range, 2 to 11 days). Mild pain was reported by some patients. The mean duration of chest-tube drainage was 2.7 days (range, 1 to 9 days). Patients with malignant disease lived an average of 12.4 months (range, 1 to 61 months) after the procedure. CONCLUSIONS: Thoracoscopic talc poudrage is an effective pleural sclerosing technique and is relatively painless.

Acute care of mild to moderately severe asthma in 1990.

When considering the acute treatment of mild to moderately severe asthma in the outpatient or emergency room setting, the author indicates how older, effective modalities of care can be replaced with modalities which are at least as effective but also teach the patient how to care for himself. Older approaches including epinephrine injections, intravenous aminophylline, intravenous superhydration, nebulizer-generated aerosols, and oxygen have the disadvantage of binding the patient to the emergency room for future attacks. By stressing proper use of sympathomimetic metered-dose inhalers (often with a spacer), oral theophyllines, oral B-2 agonists, oral and inhaled corticosteroids, the 90% of patients well enough to go home after treatment will have had a lasting educational experience designed to increase their self-reliance and make further ER visits unnecessary.

Foreign body aspiration in the adult: an occult cause of chronic pulmonary symptoms.

We describe two otherwise healthy subjects with many years sequelae due to lung aspiration. In both, diagnosis was delayed due to lack of history of aspiration. Recurrent pneumonia in the same segment in one, and migratory pneumonia in the other, could have suggested the diagnosis. Review of the literature shows that occult foreign body aspiration poses difficulties in diagnosis and that often a history of aspiration is lacking. However, the recurrent nature and the localization of the pneumonia, as well as the findings during bronchoscopy, should alert the physician to the possibility of foreign body aspiration.

"Noninvasive" oral treatment of asthma in the emergency room.

One hundred forty consecutive patients with acute asthmatic episodes presenting to the emergency room were studied prospectively to assess the efficacy of oral therapy. After the emergency room staff was oriented to the pharmacologic action of hydroalcoholic elixir of theophylline, oral terbutaline, and a metered-dose hand-held nebulizer (metaproterenol), use of oral therapy as initial therapy rose from 12 percent to 76 percent (p = 0.005). More than half of these patients were discharged without receiving any of the traditional more invasive therapies of subcutaneous epinephrine, intravenous hydrating fluids with aminophylline, and machine-delivered sympathomimetic aerosols. Oral therapy did not substantially alter the total time spent in the emergency room. Only 4 percent treated with oral therapy required further treatment in the emergency room within 48 hours; 2 percent vomited after treatment. Oral therapy is safe and effective for most asthmatic patients presenting to the emergency room, as they generally are undermedicated with regard to theophyllines and sympathomimetic drugs. Use of oral therapy in the emergency room is a potent tool for educating asthmatic patients in the use of medication available for home use. The patients who require emergency room treatment despite being well-medicated at home (a small minority) need a higher level of care including intermittent positive-pressure breathing, corticosteroids, and often hospitalization.