Papers by Rekha Chaudhuri
The Journal of the Association of Physicians of India
Heart and Lung The Journal of Acute and Critical Care
To study the clinical profile and cholinesterase levels of subjects of organophosphate and carbam... more To study the clinical profile and cholinesterase levels of subjects of organophosphate and carbamate poisoning and to identify those subjects who would require ventilatory support. Prospective, observational study. Intensive care unit of a tertiary care urban hospital. Fifty-two patients admitted with a diagnosis of organophosphate or carbamate poisoning. Subject survival and ventilator requirement. Treatment with atropine and pralidoxime and mechanical ventilation for patients with respiratory failure. Clinical features were monitored at every stage, and blood for plasma and red blood cell cholinesterase levels was collected on admission. According to the ingested poison, subjects were divided into four groups: organophosphates (13 subjects), mixed organophosphate and carbamate (18), carbamates (13), and a fourth miscellaneous group (8). Dyspnea and vomiting were the most common symptom and miosis and cyanosis were the most frequently observed signs. Plasma and red cell cholinesterase levels were lowest in the mixed poison group and highest in the carbamate group. Twenty-seven subjects developed Type I respiratory failure and 7 had Type II respiratory failure. Mechanical ventilation was required in 31 subjects. Overall 33 subjects survived. A scoring system, on a point scale of 16, was developed using miosis, unconsciousness, fasciculations, and plasma cholinesterase levels to predict ventilator requirement. This study helps to identify at an early stage those patients with organophosphate or carbamate poisoning who would ultimately require ventilatory support. We found miosis, unconsciousness, fasciculations, and a low plasma cholinesterase level to be of greatest predictive value.
The Journal of the Association of Physicians of India
The Journal of the Association of Physicians of India
Current Therapeutic Research, 1993
ABSTRACT The efficacy and safety of the fluoroquinolone pefloxacin was evaluated in 55 patients w... more ABSTRACT The efficacy and safety of the fluoroquinolone pefloxacin was evaluated in 55 patients with nosocomial respiratory tract infections. Eighteen patients had bronchiectasis, 14 had chronic obstructive pulmonary disease, 9 had lung abscess, 6 had pneumonia, 3 had bronchial asthma with infection, 2 had interstitial lung disease with infection, and 1 patient each had empyema, infected lung cyst, and hydropneumothorax. All patients suffered from cough. Forty-two (76%) of the 55 patients had dyspnea, 33 (60%) had rhonchi, and 22 (40%) had fever. Klebsiella and Pseudomonas species were isolated from the sputum of 18 and 17 patients, respectively, Two patients were infected with Acinetobacter, 3 with staphylococci, 2 with streptococci, 2 were infected with Streptococcus pneumoniae, and 1 each with Haemophilus influenzae, and Escherichia coli. In 12 patients, no organisms were isolated from the sputum. All patients were treated with pefloxacin 400 mg twice daily for 10 to 14 days. In 36 (84%) of the 43 patients with positive cultures, pefloxacin therapy eradicated the organisms. The organisms persisted in seven (16%) patients. Clinical cure was observed in 10 (18%) of the 55 patients, improvement was seen in 39 (71%) patients, and failure occurred in 6 (11%) patients. Pefloxacin therapy did not affect biochemical values. One patient complained of mild headache, but this side effect was not directly attributable to pefloxacin treatment. Pefloxacin should be considered as an alternative to multi-drug therapy for the treatment of nosocomial respiratory tract infections.
European Respiratory Journal, 2015
Pulmonary Pharmacology & Therapeutics, 2015
Statins have pleiotropic immunomodulatory effects that may be beneficial in the treatment of asth... more Statins have pleiotropic immunomodulatory effects that may be beneficial in the treatment of asthma. We previously reported that treatment with atorvastatin improved asthma symptoms in smokers with asthma in the absence of a change in the concentration of a selection of sputum inflammatory mediators. To determine the effects of atorvastatin alone and in combination with inhaled corticosteroid on a range of sputum cytokines, chemokines and growth factors implicated in the pathogenesis of asthma, and their association with asthma control questionnaire (ACQ) and/or asthma quality of life questionnaire (AQLQ) scores. Sputum samples were analysed from a sub-group of 39 smokers with mild to moderate asthma recruited to a randomised controlled trial comparing atorvastatin (40 mg/day) versus placebo for four weeks, followed by inhaled beclometasone (400 μg/day) for a further four weeks. Induced sputum supernatant fluid was analysed (Luminex or biochemical analyses) for concentrations of 35 mediators. Sputum mediator concentrations were not reduced by inhaled beclometasone alone. Atorvastatin significantly reduced sputum concentrations of CCL7, IL-12p70, sCD40L, FGF-2, CCL4, TGF-α and MMP-8 compared with placebo and, when combined with inhaled beclometasone, reduced sputum concentrations of MMP-8, IL-1β, IL-10, MMP-9, sCD40L, FGF-2, IL-7, G-CSF and CCL7 compared to ICS alone. Improvements in ACQ and/or AQLQ scores with atorvastatin and ICS were associated with decreases in G-CSF, IL-7, CCL2 and CXCL8. Short-term treatment with atorvastatin alone or in combination with inhaled beclometasone reduces several sputum cytokines, chemokines and growth factors concentrations unresponsive to inhaled corticosteroids alone, in smokers with asthma.
Thorax, 2016
To determine the prevalence of systemic corticosteroid-induced morbidity in severe asthma. Cross-... more To determine the prevalence of systemic corticosteroid-induced morbidity in severe asthma. Cross-sectional observational study. The primary care Optimum Patient Care Research Database and the British Thoracic Society Difficult Asthma Registry. Optimum Patient Care Research Database (7195 subjects in three age- and gender-matched groups)-severe asthma (Global Initiative for Asthma (GINA) treatment step 5 with four or more prescriptions/year of oral corticosteroids, n=808), mild/moderate asthma (GINA treatment step 2/3, n=3975) and non-asthma controls (n=2412). 770 subjects with severe asthma from the British Thoracic Society Difficult Asthma Registry (442 receiving daily oral corticosteroids to maintain disease control). Prevalence rates of morbidities associated with systemic steroid exposure were evaluated and reported separately for each group. 748/808 (93%) subjects with severe asthma had one or more condition linked to systemic corticosteroid exposure (mild/moderate asthma 3109/3975 (78%), non-asthma controls 1548/2412 (64%); p<0.001 for severe asthma versus non-asthma controls). Compared with mild/moderate asthma, morbidity rates for severe asthma were significantly higher for conditions associated with systemic steroid exposure (type II diabetes 10% vs 7%, OR=1.46 (95% CI 1.11 to 1.91), p<0.01; osteoporosis 16% vs 4%, OR=5.23, (95% CI 3.97 to 6.89), p<0.001; dyspeptic disorders (including gastric/duodenal ulceration) 65% vs 34%, OR=3.99, (95% CI 3.37 to 4.72), p<0.001; cataracts 9% vs 5%, OR=1.89, (95% CI 1.39 to 2.56), p<0.001). In the British Thoracic Society Difficult Asthma Registry similar prevalence rates were found, although, additionally, high rates of osteopenia (35%) and obstructive sleep apnoea (11%) were identified. Oral corticosteroid-related adverse events are common in severe asthma. New treatments which reduce exposure to oral corticosteroids may reduce the prevalence of these conditions and this should be considered in cost-effectiveness analyses of these new treatments.
European Respiratory Journal, Sep 1, 2012
Number: 4697 Publication Number: P1757 Abstract Group: 3.1. Molecular Pathology and Functional Ge... more Number: 4697 Publication Number: P1757 Abstract Group: 3.1. Molecular Pathology and Functional Genomics
European Respiratory Journal, Sep 1, 2012
Number: 5047 Publication Number: P2232 Abstract Group: 5.2. Monitoring Airway Disease Keyword 1: ... more Number: 5047 Publication Number: P2232 Abstract Group: 5.2. Monitoring Airway Disease Keyword 1: Asthma -mechanism Keyword 2: COPD -mechanism Keyword 3: Smoking Title: Chronic mucus hypersecretion in asthma: Relation to smoking status and disease severity Dr. Rekha 15978 Chaudhuri [email protected] MD 1 , Dr. Charles
European Respiratory Journal, Sep 1, 2014
European Respiratory Journal, Sep 1, 2013
Body: Background Elevated serum periostin is associated with airway eosinophilia in non-smokers w... more Body: Background Elevated serum periostin is associated with airway eosinophilia in non-smokers with asthma and may predict response to therapies targeting Th 2 inflammation. Smoking in asthma is associated with non-eosinophilic airway inflammation and corticosteroid insensitivity. We determined the effects of smoking status on serum periostin and airway expression in asthma. Methods Serum periostin (ELISA; Aviscera Bioscience) and airway (nasal) epithelial POSTN expression (210809_s_at on U133+2 chips) were measured in asthmatic and healthy subjects . Serum periostin was also measured before and after two week oral steroids in another asthma group (n=45). Data (median IQR) was analysed by Kruskal-Wallis test. Results Serum periostin was reduced by smoking in both asthmatic (p=0.017) and healthy subjects (p=0.063). Periostin was not influenced by disease severity (p=0.786). Oral steroid treatment reduced serum periostin (p=0.030), particularly in non-smokers with asthma. POSTN expression was similar in non-smokers and smokers with severe asthma, but lower in healthy smokers (p=0.002). Table 1 Serum periostin and airway POSTN expression Serum periostin (ng/ml) Airway (nasal) POSTN expression Healthy non-smokers 49 (9, 1275) [n=24] 3799 (249, 3578) [n=17] Healthy smokers 9 (9, 76) [n=18] 1067 (538, 2229) [n=14] Asthma non-smokers 280 (9, 4027) [n=32] 2420 (1643, 9533) [n=14] Asthma smokers 9 (9, 330) [n=54] 2634 (1717, 4769) [n=17]
The study by Chaudhuri and colleagues (1) showed that cigarette smoking impairs the efficacy of c... more The study by Chaudhuri and colleagues (1) showed that cigarette smoking impairs the efficacy of corticosteroid therapy in subjects with asthma. Furthermore, the authors found a partial response to corticosteroids in the group of ex-smokers, suggesting that smoking-...
Trials, Jan 10, 2015
Chronic obstructive pulmonary disease (COPD) is associated with high morbidity, mortality, and he... more Chronic obstructive pulmonary disease (COPD) is associated with high morbidity, mortality, and health-care costs. An incomplete response to the anti-inflammatory effects of inhaled corticosteroids is present in COPD. Preclinical work indicates that 'low dose' theophylline improves steroid responsiveness. The Theophylline With Inhaled Corticosteroids (TWICS) trial investigates whether the addition of 'low…
The Journal of allergy and clinical immunology, 2004
... Status: Published. Refereed: Yes. Authors: Livingston, E, Darroch, CE, Chaudhuri, R, McPhee, ... more ... Status: Published. Refereed: Yes. Authors: Livingston, E, Darroch, CE, Chaudhuri, R, McPhee, I, McMahon, AD, MacKenzie, SJ and Thomson, NC. College/School: College of Medical Veterinary and Life Sciences. Journal Name: Journal of Allergy and Clinical Immunology. ...
The high prevalence of cigarette smoking in patients with respiratory disease puts them at risk o... more The high prevalence of cigarette smoking in patients with respiratory disease puts them at risk of developing clinically important drug interactions. Cigarette smoking reduces the therapeutic response to certain drugs such as theophyllines through the induction of hepatic cytochrome P450 isoenzymes. Smokers with asthma and patients with COPD have reduced sensitivity to corticosteroids, possibly due to non-eosinophilic airway inflammation, altered glucocorticoid receptor activity or reduced histone deacetylase activity. Although all smokers should be encouraged to stop smoking, there is limited information on the influence of smoking cessation on the therapeutic and anti-inflammatory effects of a number of the drugs used in the treatment of respiratory disease.
Cigarette smoking in asthma is associated with poor symptom control and reduced sensitivity to co... more Cigarette smoking in asthma is associated with poor symptom control and reduced sensitivity to corticosteroids. We summarize recent evidence supporting the adverse effects of smoking in asthma and consider strategies to manage these patients. Smokers have more severe symptoms and are more likely to be admitted to hospital due to poorly controlled asthma compared with nonsmokers with asthma. Possible causes of reduced sensitivity to inhaled corticosteroids in smokers with asthma are noneosinophilic airway inflammation, impaired glucocorticoid receptor function, and/or reduced histone deacetylase activity. Smoking cessation improves asthma control, but quit rates are low. The optimal drug therapy for smokers with asthma is not established due, in part, to the small number of clinical trials performed in these patients. Preliminary data, however, suggest that leukotriene-receptor antagonists may have a beneficial effect in smokers with mild asthma. Cigarette smoking in asthma is a risk factor for poor asthma control and reduced sensitivity to corticosteroids. Every effort should be made to encourage individuals with asthma who smoke to quit. Clinical trials are required to identify therapies that restore corticosteroid sensitivity or directly improve symptom control in individuals with asthma who are unable to stop smoking.
Omalizumab, a humanized monoclonal antibody that binds circulating IgE antibody, is a treatment o... more Omalizumab, a humanized monoclonal antibody that binds circulating IgE antibody, is a treatment option for patients with moderate to severe allergic asthma whose asthma is poorly controlled with inhaled corticosteroids and inhaled long-acting β 2 agonist bronchodilators. This review considers the mechanism of action, pharmacokinetics, efficacy, safety and place in management of omalizumab in asthma and focuses particularly on key articles published over the last three years. Omalizumab reduces IgE mediated airway inflammation and its effect on airway remodeling is under investigation. Recent long-term clinical trials confirm the benefits of omalizumab in reducing exacerbations and symptoms in adults and in children with moderate to severe allergic asthma. No clinical or immunological factor consistently predicts a good therapeutic response to omalizumab in allergic asthma. In responders, the duration of treatment is unclear. The main adverse effect of omalizumab is anaphylaxis, although this occurs infrequently. Preliminary data from a five-year safety study has raised concerns about increased cardiovascular events and a final report is awaited. Clinical trials are in progress to determine whether omalizumab has efficacy in the treatment of non-allergic asthma.
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Papers by Rekha Chaudhuri