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Hypersensitivity reactions to nonsteroidal anti-inflammatory drugs (NSAIDs): short update

Roxana Silvia Bumbăcea1,2, Sandra Olariu2, Dragoș Bumbăcea3,4, Irina Strâmbu3,5
1. U.M.F. „Carol Davila“ București, Disciplina de Dermatologie Oncologică și Alergologie 2. Spitalul Universitar de Urgență „Elias“ București, Compartimentul Alergologie 3. U.M.F. „Carol Davila“ București, Disciplina de Pneumologie 4. Spitalul Universitar de Urgență „Elias“ București, Departamentul Pneumologie 5. Institutul de Pneumoftiziologie „Marius Nasta“ București
Hypersensitivity reactions to nonsteroidal anti-inflammatory drugs (NSAIDs): short update
Hypersensitivity reactions to aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) are a challenge to the clinicians, due to their severity. In susceptible individuals, NSAIDs induce a wide spectrum of reactions with various timing and organ manifestations, involving immunological and non-immunological mechanisms.
Diagnosis of hypersensitivity to NSAID is based on characteristic symptoms precipitated with ASA/ NSAIDs. Oral challenge with NSAID is the "gold standard" for the diagnosis and can be performed in order to confirm hypersensitivity to the culprit drug or to confirm or exclude tolerance to an alternative drug.
Diagnosis process includes understanding of the underlying mechanism, and is mandatory for prevention of future events.
Keywords: hypersensitivity, NSAIDs, aspirin, asthma

Uptodate in the management and treatment of ANCA-associated vasculitis

Ionela Nicoleta Belaconi1,2, Claudia Lucia Toma1,2, Miron Alexandru Bogdan1,2
1. Institutul de Pneumoftiziologie „Marius Nasta“, București 2. Universitatea de Medicină și Farmacie „Carol Davila“ București

The antineutrophil cytoplasm antibody (ANCA)-associated vasculitis are heterogeneous, multisystem, autoimmune diseases characterized by necrotizing small and medium vessel vasculitis and the association with ANCA. The diagnosis and management of these patients may be challenging due to the variability of clinical features, the possibility of life-threatening events (acute renal failure or pulmonary hemorrhage) and the relative rarity of these syndromes. ANCA-associated vasculitis include granulomatosis with polyangiitis, microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis. The treatment requires significant immunosuppression and there are frequent treatment related side effects. Although the standard protocol with cytotoxic agents and glucocorticoids has dramatically improved patient outcome, its toxic profile remains a major problem. Recent progress in evidence base and consensus in understanding the pathogenic mechanism and the quantification of disease activity further improved patient's life. Special attention was paid in refining immunosuppressive treatment to minimize his toxicity. This review will focus on evidence based treatment of ANCA-associated vasculitis.

Keywords: vasculitis, ANCA, treatment

Evidences related to pulmonary rehabilitation in the respiratory pathology

Alina Croitoru1, Miron Alexandru Bogdan1,2
1. Institutul de Pneumoftiziologie „Marius Nasta“ București 2. Universitatea de Medicină și Farmacie „Carol Davila“ București

Pulmonary rehabilitation represents a modern therapeutic approach of respiratory diseases, with a multidisciplinary character, including: physical training, therapeutic education, psychosocial counseling, and nutritional approach. Pulmonary rehabilitation addresses to any patient suffering from pulmonary pathology whose quality of life is affected by the respiratory symptoms, regardless of the degree of functional impairment.
This article is an analysis of evidences from the medical literature on outcomes of rehabilitation programs conducted in various lung diseases.
The main indication of pulmonary rehabilitation is the chronic obstructive pulmonary disease - COPD (stable state and exacerbation) in which most studies were carried out.
Pulmonary rehabilitation in patients with other respiratory pathology has its reason in the pathophysiological changes that they undergo (impaired lung function and gas exchange, muscle atrophy and deconditioning etc.) leading to symptoms, lower exercise tolerance and decrease daily physical activity, all of which ultimately result in impaired quality of life.
The role of rehabilitation is reviewed in the following diseases: post-surgical lung volume reduction for emphysema, asthma, bronchiectasis, interstitial lung disease, cystic fibrosis, lung cancer, neuromuscular disease, intensive care, obstructive sleep apnea, pulmonary hypertension, post-tuberculous sequelae, lung transplantation.

Keywords: pulmonary rehabilitation, respiratory diseases, exercise, evidence