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Biomedical subjects

Miles Weinberger

Publications and source records attributed to Miles Weinberger.

18 recordsLinked to original sources
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↗
PubMed2002

Unusual cause of chronic cough in a four-year-old cured by uvulectomy.

A 4-year-old boy had a history of persistent barking cough unresponsive to medical treatment since infancy. He described a feeling of something in his throat. When investigated by flexible fiberoptic bronchoscopy, the only abnormality was the uvula resting in contact with the epiglottis. The cough was no longer present after uvulectomy.

Bronchoscopy↗
PubMed2002

Airways reactivity in patients with CF.

Airways reactivity, hyper-reactivity, and hyper-responsiveness are terms used to describe airways for which there appears to be increased bronchial smooth muscle tone or responsiveness. Some patients with cystic fibrosis (CF) have concomitant asthma causing airway hyperresponsiveness as manifested by recurrent acute symptoms of dyspnea that is impressively responsive to an inhaled beta 2 agonist and/or systemic corticosteroids. However, many others have a degree of bronchodilator responsiveness in the absence of an impressive clinical response to such anti-asthmatic treatment. In contrast to those with asthma, exercise does not induce bronchospasm and can even cause bronchodilatation in patients with CF who have bronchodilator responsiveness in the absence of asthma. The airway hyperresponsiveness of CF also differs in its response to histamine induced bronchospasm which is effectively reversed with ipratropium in patients with CF who symptomatically do not have asthma, whereas ipratropium does not adequately reverse histamine-induced bronchospasm in those with concomitant symptoms of asthma. These and other data suggest that the increased airway reactivity in patients with CF is vagally mediated and results from the airway damage caused by the lung disease. The use of bronchodilators as a routine part of CF lung disease care is controversial, but there is little evidence that treating airway reactivity in patients with CF is of clinical importance as a routine measure in the absence of clinical asthma. Definite subjective improvement in symptoms or improved sputum production when a bronchodilator precedes chest physical therapy should be sought to justify continued use in individual patients.

Airway Obstruction↗