Internal Medicine

P1: SBT

0521779407-04 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:8

Aspergillosis Asthma 171

complications and prognosis

Prognosis

■Invasive disease:

➣Extremely high mortality in the immunocompromised host, even

with prompt therapy

➣Sinus: 50% mortality

➣CNS: up to 100% mortality

Prevention

■Use of rooms with high-efficiency particulate air filters (HEPA) in

severely neutropenic patients (such as bone marrow transplant) may

have efficacy.

Asthma............................................

STEPHEN C. LAZARUS, MD

history & physical

History

■Recurrent chest tightness, dyspnea, wheezing, cough (may be only

symptom)

■Onset in childhoold or as adult

■Frequent or severe “chest colds”

■Associated with family/personal history of atopy, allergic rhinitis

■More prevalent in male children, female adults

■Samter syndrome (“triad asthma”): nasal polyps, ASA sensitivity;

asthma (3–10%)

■Early childhood infections may protect against asthma by favoring

TH1 (vs TH2) phenotype (hygiene hypothesis)

Signs & Symptoms

■Exam may be normal

■Prolonged expiratory phase, wheezes, sternocleidomastoid retrac-

tions

■With severe obstruction, chest may be quiet

■Neither symptoms nor exam are predictors of severity of airflow

obstruction