- |||||||||| chlorpheniramine / Generic mfg., dexamethasone injection / Generic mfg., epinephrine / Generic mfg.
A Curious Case of Cocaine Induced Quincke's Disease (San Diego Convention Center, Area K (Hall H, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_5993;
This is a lethal condition as it is an acute spontaneous presentation that must be dealt with, in a timely manner with vigilance to prevent progression and complications. Hence, initial management would focus on restoring and ensuring a safe airway.
- |||||||||| prednisone / Generic mfg., mycophenolate mofetil / Generic mfg., methylprednisolone sodium succinate / Generic mfg.
Meningoencephalitis With Transverse Myelitis in a Patient With West Nile Virus - Clinical Insights and Awareness (San Diego Convention Center, Area E (Hall A-B2, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_5954;
Case: 42-year-old male with history of end-stage-renal-disease secondary to type 1 diabetes status post simultaneous pancreas-kidney transplant 7 years ago on immunosuppression (mycophenolate mofetil, tacrolimus, and prednisone) who originally presented with 4-5 days of fevers (T-max: 103 F) and confusion...He was trialed with IVIG x2 doses, IV solumedrol 1000 mg x5 doses, and plasmapheresis x5 sessions throughout his clinical course which did improve imaging findings on MRI head and cervical spine but unfortunately with minimal clinical or neurologic improvement...Given that TM is similar to the acute flaccid paralysis syndrome associated with WN Virus and previous case reports have demonstrated possible role for plasmapheresis. Overall in our case, treatment response was limited, but this may be due to the timing of interventions, immunocompromised state, or overall severity of neurologic insult.
- |||||||||| dexamethasone / Generic mfg.
Changing Landscape of Haemophilus Influenzae Meningitis and Implications for Public Health (San Diego Convention Center, Area E (Hall A-B2, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_5951;
The patient's condition improved after 14 days of antibiotics and dexamethasone...Therefore, further exploration into diverse modalities for monitoring ICP in patients with bacterial meningitis and elevated ICP is needed. With increasing prevalence of NTHi and its increase in invasive pattern it is crucial to implement vaccination strategies and develop new vaccines targeting NTHi.
- |||||||||| methylprednisolone sodium succinate / Generic mfg.
Simultaneous Subcutaneous Emphysema, Pneumothorax and Pneumomediastinum - A Rare Complication of Asthma (San Diego Convention Center, Area E (Hall A-B2, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_5920;
The patient was initiated on nebulizer treatment, IV methylprednisolone, and empiric antibiotics...Additionally, the patient's clinical history suggests the presence of bacteremia, which may have further complicated into endocarditis. However, with patient's family opting for hospice care, a comprehensive evaluation was not pursued.
- |||||||||| Feiba (human plasma derived anti-inhibitor coagulant complex) / Takeda
Acquired Hemophilia a Presenting as Airway Emergency Resulting in Airway Compromise Requiring Urgent Tracheostomy (San Diego Convention Center, Area E (Hall A-B2, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_5918;
After discussion with Hematology, patient was initiated on triple therapy including IVIG, steroids, and Cyclophosphamide...Therefore, early recognition and testing is important to reduce subsequent deaths. Acquired hemophilia should be considered in patients experiencing spontaneous hematomas.
- |||||||||| remdesivir / Generic mfg., dexamethasone / Generic mfg.
Recurrent Hypoxia With Feeding: Uncovering the Hidden Fistula (San Diego Convention Center, Area E (Hall A-B2, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_5912;
A high index of suspicion should be present in patients with worsening oxygenation, particularly if there is an association with enteric feeding. The presence of severe, pro-inflammatory conditions such as septic shock, concurrent high-dose steroid therapy, and mechanical insults such as NGT placement may elevate the risk of BEF formation.
- |||||||||| Acute Respiratory Distress Syndrome Secondary to Covert Squamous Cell Carcinoma of the Lung: A Case Report (San Diego Convention Center, Area E (Hall A-B2, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_5903;
Case PresentationA 61-year-old woman with a medical history of heart failure with preserved ejection fraction, hypertension, insulin-dependent diabetes mellitus, and history of deep venous thrombosis on Eliquis presented to the emergency room with dyspnea...Therefore, she was empirically given dexamethasone and antibiotics with vancomycin and cefepime...Also, it is plausible that tumor cells spread via the lymphatics resulting in lymphatic obstruction and pulmonary edema mimicking ARDS. In conclusion, this case highlights the extensive differential diagnosis of non-cardiogenic pulmonary edema, including primary lung malignancy.
- |||||||||| Kineret (anakinra) / SOBI, Ilaris (canakinumab) / Novartis
VV-ECMO as a Bridge to Recovery in ARDS Secondary to Adult-Onset Still's Disease (San Diego Convention Center, Area E (Hall A-B2, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_5898;
Rheumatology diagnosed the patient with AOSD based on meeting all major and minor Yamaguchi criteria and started Dexamethasone and Anakinra...She was extubated on hospital day 32, then discharged on hospital day 48 with 3 L supplemental oxygen, Canakinumab and prednisone taper...Multisystem organ failure may be a deterrent from VV-ECMO use given its outcome prediction in other disease states. However, we hope this case provides insight into its potential as a bridge to recovery in this population which otherwise has a poor prognosis.
- |||||||||| prednisone / Generic mfg., methylprednisolone sodium succinate / Generic mfg.
A Rare, Rapidly Progressive, Acute Presentation of Sarcoidosis With ARDS (San Diego Convention Center, Area E (Hall A-B2, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_5885;
2 Sarcoidosis with bone marrow involvement is also rare. 6 It is essential to consider this in the differential of ARDS so that appropriate treatment can be initiated timely and result in successful outcomes.
- |||||||||| Embolic Stroke and Interatrial Septal Aneurysm Masking the Diagnosis of Granulomatosis With Polyangiitis (San Diego Convention Center, Area H (Hall H, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_5693;
A 70-year-old woman with hypertension and hyperlipidemia presented with generalized weakness, fatigue, rhinorrhea, and sinusitis after treatment with cefdinir and steroids...Patient was started on colchicine, aspirin, and Plavix...She was started on solumedrol and rituximab was added subsequently...While there have been cases of eosinophilic granulomatosis with polyangiitis presenting with ischemic strokes and vision loss, there are few published cases of GPA presenting with such complications. This case shows that GPA can present in atypical fashion with unique sequelae, leading to delay in diagnosis or misdiagnosis, further highlighting the importance of this case.
- |||||||||| prednisone / Generic mfg., methylprednisolone sodium succinate / Generic mfg.
Three P's and a Cavity: Perinuclear Anti-neutrophil Cytoplasmic Antibody (p-ANCA), Proteinase-3 (PR3) and Granulomatosis With Polyangiitis (GPA) (San Diego Convention Center, Area H (Hall H, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_5692;
The patient was assessed as having probable GPA and was started on high-dose intravenous methylprednisolone with significant clinical improvement...The patient was discharged on room air on high-dose prednisone with a plan to taper and add steroid-sparing agents as an outpatient...Limitations of IIF may account for incongruent results. This case highlights the importance of including a vasculitis work-up in isolated pulmonary nodules and the need to screen directly for ANCA antibodies via solid-phase immunoassays.
- |||||||||| Cresemba (isavuconazonium sulfate) / Astellas, Basilea, Rituxan (rituximab) / Roche
Suffocated by Autoimmunity: A Bloodbath (San Diego Convention Center, Area H (Hall H, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_5671;
Treatment included isavuconazole for a positive beta-D-glucan test, vancomycin, zosyn, and azithromycin...High dose intravenous solumedrol was administered for therapy of GPA...Both DAH and GPA management involve corticosteroids and immunotherapy with cyclophosphamide or rituximab...Timely immune modulation is crucial for lung function preservation. This case highlights having a high suspicion even in cases where upper airway and renal involvement are absent.
- |||||||||| methylprednisolone sodium succinate / Generic mfg.
A Case of Weakness and Dyspnea in a 62 Year Old Man With Rheumatoid Arthritis (San Diego Convention Center, Area H (Hall H, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_5659;
Patient received methylprednisolone and intravenous immunoglobulin (IVIG) with clinical improvement...Respiratory muscle weakness can be diagnosed with a decrease of vital capacity by 20% from the seated position to supine. A decrease in FEV1, FVC, MIP, and MEP can be found in those with profound respiratory muscle weakness
- |||||||||| Fasenra (benralizumab) / AstraZeneca
Persistent Lung Eosinophilia While on Benralizumab (San Diego Convention Center, Area H (Hall H, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_5642;
She had been on intermittent prednisone as well as Breztri 160 mcg and other treatments for CRS...Due to persistent eosinophilia on benralizumab, she is now transitioning to high-dose mepolizumab, and may start immunosuppression...Benralizumab, an IL5R antibody, rapidly facilitates antibody-dependent cell-mediated cytotoxicity to deplete eosinophils in the peripheral blood, bone marrow, and tissue. However, in this case pulmonary eosinophilia persisted despite treatment and effective blood depletion of eosinophils, suggesting altered immune mechanisms leading to persistent eosinophilia.
- |||||||||| Tezspire (tezepelumab-ekko) / AstraZeneca, Amgen, Xolair (omalizumab) / Roche, Novartis
A Combination of Tezepelumab and Omalizumab for Severe Persistent Asthma (San Diego Convention Center, Area H (Hall H, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_5640;
A while Later she was started on Azathioprine and Theophylline which showed a good effect with decreased exacerbations...Subsequently, she was desensitized to IV hydrocortisone which helped in managing her acute exacerbations, and then desensitized to oral prednisolone and kept on it chronically which helped in preventing her exacerbations...DiscussionSince Tezepelumab was added to the regimen along with Omalizumab, the patient had fewer exacerbations to 2 times/year compared to the previous year with 6 exacerbations. Theophylline was stopped completely, and prednisolone was tapered to 5 mg daily, hoping that it could be stopped completely in the near future.
- |||||||||| ketamine / Generic mfg.
Ketamine Chronicles: A Breath of Fresh Air in Status Asthmaticus (San Diego Convention Center, Area H (Hall H, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_5639;
This patient's subsequent improvement in respiratory symptoms and vital sign stabilization is evidence of ketamine's therapeutic potential in managing refractory status asthmaticus. While this case lends support to the growing interest in ketamine as a treatment option, further studies, and clinical trials are essential to fully assess its efficacy and safety and to identify potential target populations.
- |||||||||| methylprednisolone sodium succinate / Generic mfg.
Can't Catch a Breath: Acute Eosinophilic Pneumonia in a Pregnant Female (San Diego Convention Center, Area H (Hall H, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_5636;
In the ICU she was started on treatment with solumedrol with a marked improvement of her respiratory status...Patients often respond well to steroids, which is the mainstay of treatment, however AEP in underreported and poorly understood in pregnancy. In conclusion, this case emphasizes the importance of prompt recognition and treatment of a severe respiratory disease in the setting of a pregnant female.
- |||||||||| Firazyr (icatibant) / Takeda
A Rare Case of Acquired Bradykinin Mediated Angioedema Associated With Chronic Lymphocytic Leukemia (San Diego Convention Center, Area H (Hall H, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_5634;
Angioedema is rare but can be rapidly progressive and life-threatening. Providers should have a higher degree of suspicion for acquired bradykinin mediated angioedema in any patient with CLL or other plasma cell abnormality presenting with stridor or other complaints that localize to the neck.
- |||||||||| Xolair (omalizumab) / Roche, Novartis
Life-threatening Mast Cell Activation and Anaphylaxis in Mast Cell Leukemia and the Role of Omalizumab (San Diego Convention Center, Area H (Hall H, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_5632;
Despite intramuscular epinephrine, diphenhydramine, cetirizine, famotidine and dexamethasone, he remained symptomatic, requiring an epinephrine drip and escalating supplemental oxygen...He was treated sequentially with avapritinib, cladribine, imatinib and midostaurin without response...Chemotherapy with a six-day course of CLAG-M (Filgrastim, Cladribine, Cytrabine and Mixoxantrone (only G-CSF component) was initiated to reduce mast cell burden...Chemotherapy to decrease mast cell burden may potentially be combined with Omalizumab to improve MAS and prevent anaphylaxis, although this strategy remains anecdotal. However, barriers to inpatient treatment with medications restricted to outpatient use are myriad.
- |||||||||| Dupixent (dupilumab) / Sanofi, Regeneron, Tezspire (tezepelumab-ekko) / AstraZeneca, Amgen, Xolair (omalizumab) / Roche, Novartis
Hyperimmunoglobulin E Syndrome: A Rare Autoimmune Masquerade of Th2 Asthma (San Diego Convention Center, Area H (Hall H, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_5629;
Dupilumab, an anti-IL4 and IL3 monoclonal antibody, was then used and the patient had control of asthma symptoms, and a decline in serum IgE levels. This case demonstrates a rare autoimmune masquerade of Th2 asthma while also demonstrating novel treatments with biologics.
- |||||||||| Decadron (dexamethasone) / Merck (MSD)
A Case of Anaphylaxis Associated Thrombocytopenia (San Diego Convention Center, Area H (Hall H, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_5628;
No clear relationship is described between alpha-gal and allergy to penicillin-based antibiotics. Pharmacologic VTE prophylaxis was safely used in this patient despite thrombocytopenia without any apparent adverse effects.
- |||||||||| Airsupra (budesonide/salbutamol) / AstraZeneca, Avillion
ALbuterol-budesonide Treatment in Acute Airway Obstruction: Design of the ALTA Study (San Diego Convention Center, Area F (Hall A-B2, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_5619;
P3
Pharmacologic VTE prophylaxis was safely used in this patient despite thrombocytopenia without any apparent adverse effects. ALTA will provide new physiologic and molecular/genomic data on the effects of combining albuterol and budesonide vs albuterol alone in the treatment and prevention of bronchoconstriction.
- |||||||||| fluticasone / Generic mfg.
Acute Asthma Outcomes Comparison: Low and Medium Dose Inhaled Corticosteroids After Hospitalization (San Diego Convention Center, Area F (Hall A-B2, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_5614;
Physicians may prefer a low dose as the first choice after a hospital admission if a patient is ICS naive to avoid medication side effects. However, additional studies with larger sample sizes should be done to determine the optimal dosing regimen for post-hospital ICS therapy in pediatric asthma populations.
- |||||||||| Three-year Follow-up in the Selection of Inhalation Therapies for Severe Asthma in Japan (San Diego Convention Center, Area F (Hall A-B2, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_5608;
In addition, the approval of the single-inhaler triple therapy has made LAMA easier to use and its use has increased. It is important to select the right inhaler for each patient from a variety of inhalers based on type of device and combination of medication.
- |||||||||| Airsupra (budesonide/salbutamol) / AstraZeneca, Avillion
Efficacy of As-needed Albuterol-budesonide by Baseline Blood Eosinophil Count in Patients ?18years With Moderate-to-Severe Asthma (San Diego Convention Center, Area F (Hall A-B2, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_5597;
P3
As-needed albuterol-budesonide reduced the risk of a severe exacerbation compared with as-needed albuterol across baseline BEC thresholds which included nearly all patients analyzed with moderate-to-severe asthma. These findings are consistent with those from the Novel START study in mild asthma, which found the effect of as-needed budesonide-formoterol on exacerbations did not support a strong relationship between baseline BEC and severe exacerbation risk.
- |||||||||| Extrafine Formulation Single-inhaler Triple Therapy Improves Lung Function After Six Months of Treatment in Patients With Asthma: Trimaximize Study (San Diego Convention Center, Area F (Hall A-B2, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_5586;
These findings are consistent with those from the Novel START study in mild asthma, which found the effect of as-needed budesonide-formoterol on exacerbations did not support a strong relationship between baseline BEC and severe exacerbation risk. Significant improvement in lung function, including parameters of central (FEV1) and peripheral (sRtot) airflow limitation as well as hyperinflation (RV/TLC) and reduction of rescue medication was observed six months after switching to efSITT from ICS/LABA or other combination of ICS/LABA/LAMA.
- |||||||||| Trelegy Ellipta (fluticasone furoate/umeclidinium bromide/vilanterol) / GSK, Innoviva, Theravance Biopharma
CT Mucus Score Predicts Response to 6-weeks ICS/LABA/LAMA in Moderate Asthma (San Diego Convention Center, Room 25A-C (Upper Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_5555;
P3
These findings align with previous work in COPD patients,2 which reported that the addition of the LAMA to their treatment regime reduced bronchoconstriction and mucus secretion. This preliminary report suggests similar benefits for patients with moderate asthma, so that CT mucus-score may be used as a potential biomarker for targeted therapy decision-making in asthma.
- |||||||||| Breztri Aerosphere (budesonide/formoterol fumarate/glycopyrronium) / AstraZeneca, Trikafta (elexacaftor/tezacaftor/ivacaftor) / Vertex
Changes in Individual Ventilation Defects in Cystic Fibrosis After Initiation of Modulator Therapy, in the Hypoint Trial (San Diego Convention Center, Room 25A-C (Upper Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_5547;
Tracking individual ventilation defects over time is possible and demonstrates changes that begin to provide evidence of the resolution of underlying pathologies like mucus plugs in specific lung segments and subsegments. Understanding regional changes to treatment can improve our understanding of disease and personalized medicine.
- |||||||||| Breztri Aerosphere (budesonide/formoterol fumarate/glycopyrronium) / AstraZeneca
Incidence and Predictors of Long-term Hypnotic Use Among Patients With Chronic Obstructive Pulmonary Disease (Marriott Marquis San Diego Marina, Pacific Ballroom 15-17 (Ground Floor, North Tower)) - Feb 20, 2024 - Abstract #ATS2024ATS_5107;
We identified patients without prior hypnotic use who received at least 30 days of zolpidem, melatonin, trazodone, or doxepin within a 90-day period...Despite guideline recommendations, long-term hypnotic use is common among patients with COPD. Future work to prevent long-term hypnotic use should consider the role of respiratory symptoms and mental health comorbidities in driving this practice.
- |||||||||| Breztri Aerosphere (budesonide/formoterol fumarate/glycopyrronium) / AstraZeneca
Improving Use of Medication Inhalers: Factors Linked to Suboptimal Inhaler Use (San Diego Convention Center, Room 8 (Upper Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_4896;
To address the COPD readmission rate, adequate patient training in medication inhaler use is needed as reported by others. 2.
- |||||||||| hydrocortisone / Generic mfg.
The Silent Intruder: Recognizing Pituitary Metastasis in Small Cell Lung Cancer (San Diego Convention Center, Area J (Hall H, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_4516;
He was given hydrocortisone, but progressively worsened despite maximum support...Hormone replacement therapy can be used in hypopituitarism and chemotherapy to the primary malignancy can be considered. Unfortunately, the prognosis remains poor, with an average survival of six months and an overall mortality rate of 90%.
- |||||||||| budesonide/formoterol / Generic mfg., fluticasone propionate/salmeterol xinafoate inhalation powder / Generic mfg.
Inhaled Corticosteroids Accelerate Aging in the Airways of COPD Patients (San Diego Convention Center, Area F (Hall A-B2, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_4436;
The clinical impact of these changes is uncertain. Long-term studies are needed to understand the full clinical impact of these findings.
- |||||||||| dexamethasone / Generic mfg.
The Novel Mitochondrial Uncoupler, EP4, Reduces Disease Features in Obesity-Associated Severe Asthma (TDP23) - Feb 20, 2024 - Abstract #ATS2024ATS_4363;
Mice were then re-challenged with Ova (days 33-34) in the absence, or presence, of dexamethasone (DEX; 2mg/kg) to model inhaled corticosteroid therapy...Interestingly, treatment with EP4 at 10mg/kg suppressed steroid-insensitive AHR in HFD/obesity-induced experimental asthma.CONCLUSION. Treatment with EP4 in HFD/obesity and HFD/obesity-induced experimental asthma reduces normally intractable AHR, justifying further investigation of EP4
- |||||||||| dexamethasone / Generic mfg., prednisone / Generic mfg., hydrocortisone / Generic mfg.
Impact of Corticosteroids on Cardiovascular Events in Critically Ill Patients With COVIDd-19 (San Diego Convention Center, Area H (Hall H, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_4104;
Our results suggest that SCS may potentially improve individual CVE such as new heart failure and acute coronary syndrome, but not the CVE composite outcome, arrhythmia and all-cause mortality when compared to no-SCS. Further studies should address the mechanisms of why SCS may impact cardiovascular outcomes.
- |||||||||| Rituxan (rituximab) / Roche
Role of Intravenous Immunoglobulin in an Immunocompromised Patient With Prolonged COVID Pneumonia (San Diego Convention Center, Area H (Hall H, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_4097;
For follicular lymphoma he was treated with bendamustine followed by rituximab infusion for maintenance of remission...Patient received treatment with high dose dexamethasone and remdesivir therapy for acute hypoxic respiratory failure secondary to presumed COVID pneumonia...He was started on solumedrol therapy with prolonged steroid taper on discharge...The role of IVIG therapy in immunocompromised patients remains controversial. The efficacy of therapy particularly in COVID patients may be related to the disease severity.
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