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Background: To evaluate long-term effectiveness of omalizumab in 'real-life' setting of Thai asthmatic patients., Methods: We conducted multi-center, observational study in severe asthma patients who received omalizumab in Thailand. Outcomes were asthma exacerbation (hospitalization and ER visit), asthma control test (ACT), and daily ICS dose. Data were evaluated at baseline, 16 Week, and 52 Week., Results: A total of 78 patients received omalizumab treatment (average duration 16.9 months with range 16 weeks-2 years). The mean annualized rate of exacerbations was reduced from baseline (3.79) at Week 16 (3.54) and Week 52 (1.16), (p<0.05), respectively. The mean hospitalization rate was reduced from 0.49 in previous year to 0.15 at Week 16 and 0.19 at Week 52. A reduction in ER visit rates was observed at Week 16 (0.15) and Week 52 (0.97) respectively from baseline (1.44) (p<0.05). The ACT score increased from 15.4 at baseline to 20.6 at Week 16 (p<0.001) and increased to 21.5 at Week 52 (p<0.001). The number of patients with controlled asthma (ACT≥20) increased from 16 of 51 at baseline to 32 of 45 at Week 16 and 25 of 32 at week 52, respectively. The median daily dose of ICS equivalent to fluticasone was reduced from baseline 680 mcg to 500 mcg at Week 52. In all, 22 patients discontinued omalizumab after 1 year. Six patients who discontinued omalizumab were restarted due to relapse of symptoms., Conclusions: These data confirms the effectiveness of one-year duration of omalizumab treatment in Thai severe asthmatic patients. Furthermore, 27% of patients who discontinued treatment required restarting due to relapse of symptoms.

Background: Nosocomial pneumonia (NP) is an important cause of morbidity and mortality in hospitalized patients. Acinetobacter baumannii is one of the common causative pathogens in NP. The prevalence of multi-drug resistance in A. baumannii has been increasing. The information on clinical features and clinical courses of A. baumannii NP in Thai patients are limited., Objective: To determine the clinical features, risk factors and clinical courses of A. baumannii NP in Thai patients hospitalized in tertiary care hospitals in Thailand., Material and Method: This was a prospective, hospital-based, active surveillance study on hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) in adults hospitalized in 12 tertiary care hospitals in Thailand between 2008 and 2009., Results: There were 651 NP patients. A. baumannii was the most common cause of NP in 198 patients (30.4%). Most of NP patients were males with median age of 71 years. About 80% had late onset NP with the median duration of 10 days after admission in both A. baumannii and non-A. baumannii NP. Most of NP occurred in patients hospitalized in general medical wards. Most of the features of NP in A. baumannii NP and non-A. baumannii NP were not significantly different. The initial antibiotics prescribed were concordant in about 50% of the patients in both groups. Colistin was usually prescribed to the patients who received antibiotic modifications. The initial clinical responses in A. baumannii NP were less favorable than those in non-A. baumannii NP. The mortality rate in A. baumannii NP seemed to be more than that in non-A. baumannii NP. There was a trend of more persistence of pathogen in A. baumannii NP. Most isolates of A. baumannii were resistant to antibiotics including carbapenems. The patients with extensive drug resistant A. baumannii NP had less favorable responses than NP due to other bacteria, including non-extensive drug resistant A. baumannii. VAP, NP developed in medical ICU and NP with bilateral lung involvements on chest X-ray were associated with A. baumannii as the isolated pathogen., Conclusion: A. baumannii is the most common causative pathogen for NP in tertiary care hospitals in Thailand and most of A. baumannii isolates were resistant to many antibiotics including carbapenems. The hospitalized patient in tertiary care hospitals with VAP, or NP that was developed in medical ICU, or NP with bilateral lung involvements on chest x-ray was likely to be due to A. baumannii. Many NP patients received inappropriate initial antibiotic regimens leading to a high mortality.

Background: Asthma is a chronic inflammatory disorder of airways and associated with airway hyperresponsiveness and reversible bronchoconstriction. Gastroesophageal reflux disease (GERD) is a disorder caused by the reflux of gastric content up into the esophagus. It has been proposed that GERD is one of the exacerbating factors in the patients with poor controlled asthma., Objective: Determine the prevalence of GERD in asthmatic patients and the association between GERD and the level of asthma control in Thailand., Material and Method: A cross-sectional descriptive study was conducted in 56 asthmatic patients at the King Chulalongkorn Memorial Hospital. They were performed twenty-four-hour esophageal pH monitoring., Results: The prevalence of GERD in Thai asthmatic patients was 37.50%. Fifteen of 21 patients (71.43%) with GERD experienced reflux symptoms. The sensitivity specificity, positive predictive value and negative predictive value of reflux symptoms for diagnosis GERD were 71.43%, 77.14%, 65.22% and 81.82%, respectively. The prevalence of GERD was higher in uncontrolled asthmatic patients than partly controlled and controlled subjects. Among uncontrolled asthma, the prevalence of GERD was higher than those without GERD (57.17% and 25.72%, respectively, p = 0.028). Asthma Control Test (ACT) score of less than twenty (poor controlled asthma) was higher in the asthmatic patients with GERD than those without GERD (80.95% and 48.57%, respectively, p = 0.024)., Conclusion: The authors concluded that the prevalence of GERD in Thai asthmatic patients was 37.50%. There was significant association between GERD and the level of asthma control.

From 1983 to 2001, 7 patients with pulmonary alveolar proteinosis were admitted to the King Chulalongkorn Memorial Hospital. Presenting symptoms varied from asymptomatic (1 patient), progressive dyspnea on exertion (4 patients) to respiratory failure (2 patients). Other symptoms included dry cough and weight loss. Gradual onset of dyspnea could be observed by average time to hospital (7 months). Early worsening of dyspnea and high-grade fever suggested a possibility of superimposed infection. Chest radiographs revealed symmetrical infiltration without lobar predominance. 4 of 7 patients were misdiagnosed as pulmonary tuberculosis before diagnosis of PAP was made. Diagnosis was made by bronchoscopic examination with typical lavage fluid or pathological results; only one case need open lung biopsy. 6 of 7 patients required lung lavage to relieve dyspneic symptoms. Coinfection with Nocardia and Mycobacterium tuberculosis was found in one patient. Prognosis was good but recurrence was common.

A 67-year-old diabetic man presented with progressive multifocal myeloradiculopathy for 6 months, with no pulmonary symptoms. A chest x-ray and CT scan of the lungs revealed bilateral multiple nodular infiltrates in the right upper lobe and the lower lobes bilaterally, mimicking metastases. A thoracoscopic lung biopsy demonstrated bronchiolitis obliterans organizing pneumonia caused by capsule-deficient cryptococcosis.