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Biomedical subjects

G W Ward

Publications and source records attributed to G W Ward.

At least 19 recordsLinked to original sources
PubMed1999

Treatment of late-onset asthma with fluconazole.

BACKGROUND: Although the etiology of intrinsic or late-onset asthma is generally not known, some cases are associated with overt dermatophyte infection and immediate hypersensitivity to proteins derived from fungi of the genus Trichophyton. OBJECTIVE: We sought to test the efficacy of oral antifungal treatment for Trichophyton-induced asthma by using fluconazole in a placebo-controlled trial. METHODS: Eleven patients with severe or moderately severe asthma were randomized to treatment with fluconazole 100 mg daily or placebo for 5 months (phase 1); during the following 5 months, all patients received active drug (phase 2). Subjects were evaluated by skin tests, bronchial provocation tests, and measurement of serum antibodies to Trichophyton species antigens. Clinical response was monitored by changes in peak flow values measured during a 2-week period at the end of each phase and by changes in bronchial sensitivity, symptoms, and steroid requirements. RESULTS: At the end of the first 5 months of active treatment, there was a highly significant decrease in bronchial sensitivity to Trichophyton (P =.012) and in oral steroid requirement (P =.01). At the end of phase 2, mean peak expiratory flow rates increased in 9 of 11 patients. An improvement in symptoms, peak flow, and steroid use was maintained up to 36 months after starting fluconazole in patients who continued to receive treatment. CONCLUSION: The results show that fluconazole can be useful in the treatment of patients with severe or moderately severe asthma who have dermatophytosis. These findings are consistent with the argument that proteins derived from fungi on the skin and nails can contribute to allergic disease.

Adult↗
PubMed1992

Aspergillus epidural abscess and cord compression in a patient with aspergilloma and empyema. Survival and response to high dose systemic amphotericin therapy.

A 57-yr-old man with a chronic lung cavity presumed to be related to ankylosing spondylitis and/or old cavitary tuberculosis presented with hemoptysis and rapidly developed lower extremity paresis and hypoesthesia. On chest radiograph he had a left upper lobe lesion suggestive of aspergilloma combined with a large left empyema with bronchopleural fistula. Serologic analysis demonstrated precipitins and very high titer IgG antibodies to Aspergillus fumigatus antigens. Decompressive laminectomy from T1 to T5 was performed, with drainage of A. fumigatus culture-positive material from an epidural abscess compressing the spinal cord. Chest drainage was required for control of the empyema. With a total course of 3 g of intravenously administered amphotericin B, rehabilitative therapy, and chronic empyema drainage, he is now at home and ambulatory with assistance. He is also being followed by regular serum assays of IgG antibodies to Aspergillus proteins. We report the case of an apparent long-term survivor of a formerly lethal and/or nonreversible paraplegic condition. The critical factors compared with previous cases with a poor outcome would appear to be prompt neurosurgical intervention, restoration of a normal number of T-cells, effective long-term chest drainage, and high dose amphotericin treatment.

Abscess↗
PubMed1991

Epidemiology of the relationship between exposure to indoor allergens and asthma.

A very high prevalence of immediate hypersensitivity to common indoor allergens can be demonstrated among children and young adults, with asthma. Recent progress in the immunochemistry of cat, dust mite and cockroach allergens has made it possible to measure exposure to these allergens and to start to define threshold levels of exposure which increase the risk of sensitization and symptomatic asthma. Indeed, it is already clear that exposure to greater than 2 micrograms group I dust mite allergen (or 100 mites) per gram of dust increases the risk of children developing sensitization and asthma. Furthermore, from studies on patients presenting to emergency rooms with asthma, it is clear that the risk of sensitization to allergens derived from cats or cockroaches or grass pollen is restricted to patients who are exposed to high levels of these allergens. Given the increasing morbidity and mortality of asthma it is clear that therapeutic efforts should be focused on identifying relevant allergens and advising patients about techniques for reducing exposure.

Air Pollution, Indoor↗
PubMed1991

Specific allergens evoking immune reactions in the lung: relationship to asthma.

Over the last 20 yrs our understanding of the relationship of allergens to asthma has changed completely. This is due to several interrelated developments: firstly, it is clear that bronchial hyperreactivity can be increased by allergen exposure and that it is at least in part reversible; secondly, it is now generally accepted that asthma involves inflammation of the bronchi in which eosinophils play an important role; thirdly, there are a large number of studies demonstrating an epidemiological relationship between immediate hypersensitivity to dust mites and asthma; finally, it has been shown that natural exposure to dust mite allergens is very different from bronchial provocation. Together these findings have lead to the view that indoor allergens can play a major role in causing bronchial inflammation with consequent bronchial reactivity and that this is usually not apparent to the patient. Recently three studies in the USA have established that immunoglobulin E (IgE) antibodies to common inhalants can also be important risk factors for acute asthma. In these studies both dust mites and pollens were significant, but cat and cockroach allergy were also important. The results imply that the management of all asthma requires evaluation of the role of immediate hypersensitivity and that treatment of inflammation in the lungs should include both anti-inflammatory drugs and allergen avoidance.

Allergens↗
PubMed1989

Trichophyton asthma: sensitisation of bronchi and upper airways to dermatophyte antigen.

12 adult patients with perennial asthma and chronic skin infection were found to have immediate hypersensitivity to Trichophyton spp. 10 patients were tested by bronchial provocation and gave immediate bronchial reactions to an extract of T tonsurans. Double-blind, placebo-controlled nasal challenge of 8 patients demonstrated that the upper airways of these patients were also sensitive to this dermatophyte antigen. In addition to perennial asthma most of the patients had persistent eosinophilia and chronic rhinosinusitis. The results suggest that absorption of fungal antigen can give rise to IgE antibody production, sensitisation of the airways, and symptomatic asthma and rhinosinusitis. Several patients had many of the features of late onset or "intrinsic" asthma.

Adult↗
PubMed1984

The national high blood pressure education program: a description of its utility as a generic program model.

The National High Blood Pressure Education Program recently celebrated its tenth anniversary. It is timely and appropriate to assess progress toward the realization of its mission and to examine the critical elements of this large-scale, community-based intervention program. This article describes the origin of the National Program, the planning process and models used in undertaking this national health education effort, the application of theoretical models, and approaches used to evaluate the effort. The lessons learned and the application of the National Program as a model for health education interventions are offered.

Cardiovascular Diseases↗
PubMed1980

Immunofluorescence of transbronchial biopsies in Goodpasture's syndrome.

Transbronchial lung biopsies were performed on 6 consecutive patients with presumptive diagnoses of Goodpasture's syndrome. Diagnoses were subsequently confirmed by the typical clinical presentation, circulating antibody to glomerular basement membrane and linear deposition of IgG on renal biopsy. We demonstrated linear deposition of IgG along the alveolar capillary basement membrane in each of the transbronchial lung biopsies. Rapid, meticulous processing allowed us to obtain reproducible results. The routine use of transbronchial lung biopsy with immunofluorescent staining is recommended for all presumptive cases of Goodpasture's syndrome.

Adolescent↗