Background: In clinical trials for bronchial asthma and ACO, triple therapy (a combination of Inhaled Corticosteroids [ICS] + Long-Acting Beta-Agonists [LABA] + Long-Acting Anticholinergics [LAMA]) is the current treatment. It has been reported to be more effective in improving respiratory function and reducing exacerbations than conventional methods. However, there are no reports verifying the effects, side effects, and efficacy in actual clinical settings.

Objective: This study aimed to investigate efficacy and biomarkers in elderly asthma and ACO patients treated with triple therapy.

Methods: This retrospective chart study included 201 patients from a single-center real-life geriatric population with bronchial asthma and Asthma-COPD Overlap (ACO) treated with ICS and LABA.

Results: Triple therapy is more effective than existing therapies in improving Asthma Control Test (ACT) results, Forced Expiratory Volume in one second (FEV1), and rates of asthma and ACO exacerbations. Our study provides evidence supporting the efficacy and safety of triple therapy in real-world geriatric settings, with no side effects that preclude its use. The reason for the good effect is that LAMA acts both as a tracheal stabilizer and a bronchodilator in patients with bronchial asthma, and because pulmonary acetylcholine in asthmatic patients may be elevated. It is possible.

Conclusion: In the real world, triple therapy should be actively used when symptoms such as high biomarker values, low FEV1 values, and a high frequency of exacerbations are observed.

Lung infections are a common complication among immunocompromised patients and they have high morbidity and mortality. The continuous use of Tumor Necrosis Factor-alpha (TNF-α) inhibitors in these patients can further worsen the infections, causing lifethreatening pneumonias. We present a 20 year old male with Crohn’s disease administered infliximab while having an active infection of the respiratory system. The infection quickly evolved to bilateral pneumonia. Empirical antimicrobial chemotherapy was initiated with colistin and cefixime and after a 19 day hospitalization the patient was symptomatically better and was discharged. At one-month’s follow up the patient reported total resolution of symptoms and a chest x-ray revealed normal findings in both lung fields. Immunocompromised patients with Crohn’s disease who are administered Tumor Necrosis Factor-alpha inhibitors are more susceptible to infections. In those patients a simple upper respiratory tract infection can quickly evolve to pneumonia, which can present with severe symptomatology and even acute respiratory failure. Clinicians must be aware of and should monitor vigilantly for such potential complications. We recommend the discontinuation of treatment with TNF-a inhibitors in patients who have an active lung infection.

Tuberculosis is a disease caused by the Mycobacterium tuberculosis complex. It typically involves the lungs and can manifest as latent tuberculosis or as an active infection. While it is treatable and preventable, according to the WHO, it remains one of the leading causes of death in the world among infectious diseases. The guidelines suggest new pulmonary tuberculosis to be treated with a 6-month multidrug regimen. In some cases an inappropriate regimen or poor patient compliance can lead to drug resistance and consequent relapse of symptoms. This has caused two types of resistant tuberculosis to emerge: multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis. We present a 29-year-old female with a medical history of tuberculosis that had not undergone adequate treatment and presented to our Emergency Department with persistent cough and hemoptysis. An initial work up was performed and the sputum smear microscopy for Acid Fast Bacilli confirmed a reactivation of tuberculosis. Subsequent tests revealed that the specimen was resistant to isoniazid, rifampicin and streptomycin, which allowed us to diagnose the relapse as multidrug-resistant tuberculosis. Despite the in vitro resistance the patient continued her treatment course with rifampicin, isoniazid, ethambutol and pyrazinamide. That led to a full resolution of her symptoms and after three consecutive negative sputum smears the patient was discharged from our clinic.