Background: Recently, BudeForu^® (BF), a generic of Symbicort Turbuhaler^® (SMB), is widely used in Japan. Although appearance of BF resembles to SMB, several differences in length, weight, and side-hole sizes are seen with precise inspection. As particle releases from the inhalation device is strongly influenced by its mechanical characteristics, we compared their particle release patterns.

Methods: An inhalation simulator generated either ramp-up or triangular (time to reach peak inhaling flow (PIF) = 0.42 s) inhalation pattern. Time trajectories of inhaled flow and released particles from either device were depicted with a photo-reflection method. Internal resistances of them were also measured.

Results: Particle release patterns of both dry powder inhalers resembled each other. Immediately after release from the inhaler, they reached the peak value and then completed in 0.5 s. In either ramp-up or triangular inspiration pattern, a single burst developed at early inhalation. There were linear relationships between PIFs and emitted doses. The regression lines using ramp-up patters were: Y = 0.00241 X - 0.039, r² = 0.700, p ＜ 0.0001 (BF), Y = 0.00210 X - 0.038, r² = 0.654, p ＜ 0.0001 (SMB), and those using triangular patterns were: Y = 0.00223X － 0.0015, r² = 0.445, p ＜ 0.0001 (BF), and Y = 0.00229X － 0.0023, r² = 0.687, p ＜ 0.0001 (SMB). Internal resistances of the BF and SMB were 0.105±0.004 and 0.119±0.105 cmH₂O^0.5/L/min respectively.

Conclusions: Present experimental study suggested that aerodynamic characteristics of BF were quite similar to those of SMB.

A 70-year-old woman undergoing long-term treatment for systemic scleroderma and secondary Sjögren syndrome developed fever during tapering of steroids. Chest CT showed centrilobular granular shadow and ground glass opacities. The pathology of transbronchial lung biopsy and the findings of bronchoalveolar lavage fluid were consistent with hypersensitivity pneumonitis and positive for anti-Trichosporon asahii antibody. Because her symptoms and imaging findings improved after house cleaning, she was diagnosed with summertype hypersensitivity pneumonitis. When lung lesions are found in patients with collagen disease, it is necessary to distinguish various diseases. In particular, allergic diseases can be difficult to diagnose by steroid therapy. In order to make an accurate diagnosis, medical history and image interpretation should be performed carefully and histologically searched as much as possible.

A 13-year-old male patient suffered several episodes of anaphylaxis during exercise after consuming wheat. Provocation tests (consisting of exercise after wheat ingestion) were conducted twice at our hospital. Both tests were positive, resulting in a diagnosis of food-dependent exercise-induced anaphylaxis (FDEIA) due to wheat. The patient was instructed to avoid exercise after wheat ingestion. The patient had also been previously diagnosed with idiopathic chronic urticaria, which was treated with antihistamines and leukotriene receptor antagonists. Since the idiopathic chronic urticaria worsened despite the use of these medications, 300 mg per four weeks of omalizumab was initiated. The patient's symptoms improved, and a third provocation test came back negative. The patient was asymptomatic without exercise restriction when treated with omalizumab. Omalizumab is not typically prescribed for treating food allergies and EIA in Japan; however, there are some reports on their effectiveness in treating them, suggesting omalizumab may also be helpful in resolving FDEIA symptoms.