There are multiple well-recognized environmental factors that contribute to asthma exacerbation. Exposures to many of them will get unrecognized and most of the time will remain constant without knowing it is the causative agent. For an early identification of exposures and causative agents, a systematic approach needs to be taken in consideration by the encountering physician. Multiple questionnaires had been implementing and discussing organic and inorganic factors as well intrinsic and extrinsic factors. It is well-recognized that environmental exposures can cause worsening of asthma, other allergic conditions and even more severe pulmonary diseases. Asthma is a very prevalent disease with increased incidence nowadays. In the last decade, multiple new medications had been discovered for the treatment of moderate-to-severe persistent asthma, which most of them target the cellular component of the disease such as eosinophils and specific Immunoglobins. In the era of personalized medicine, environmental and occupational factors in asthma are key players that need to be recognized early in this patient population. In this chapter will go over model of effects, mechanism of action of these environmental factors, recognition, course of action and management of this patient population.

Acute foreign body aspiration can cause severe damage to the respiratory system, leading to laceration and even death due to asphyxia. However, a foreign body that has been aspirated could go unnoticed acutely and lead to persistent shortness of breath symptoms. Most of the patients will be able to recall the acute aspiration event, but others do not. On the latter, a more meticulous approach will lead to the diagnosis and subsequent effective management. We hereby present the case of a 52-year-old male with history of partly controlled severe asthma and chronic persistent cough with bloody sputum. Upon evaluation, he was found with a right-sided pneumonia and pertinent history remarkable for several episodes of bronchitis in the past 3 years. There circumstances and subsequent images led to the successful finding and removal of a chronic foreign body aspirated 3 years prior to evaluation. A procedure led to almost complete resolution of symptoms of cough and asthma.

Septic Iliac vein thrombophlebitis with associated psoas abscess is a rare and severe entity, which diagnosis is challenging when no risk factor is clearly present. We are presenting a case of severe septic cavitary pulmonary emboli complicated with Acute Respiratory Distress Syndrome (ARDS) that evolved rapidly to respiratory distress and multi organ failure. A 61-year-old Hispanic male, had multiple emergency department visits due to back pain, being most of them intramuscular pain medications and steroids. In the history, he had back pain that worsened accompanied by poor mobility, generalized malaise, fever and chills. Computed tomography (CT) scan showed a paravertebral psoas abscess with L5-S1 diskitis/spondylitis infl ammatory changes, which was then later evidenced by a gallium study. Further imaging studies were done, showed bilateral cavitary lung lesions, consistent with septic emboli. Subsequent blood cultures were positive for Methicillin Resistant Staphylococcus Aureus (MRSA), for which a successful combined therapeutic regimen was used. Transthoracic and transesophageal echocardiogram were not suggestive of endocarditis. Staphylococcus aureus (SA) bacteremia is one of the most common serious bacterial infections with a high risk of metastatic complications, which makes this pathogen a unique one. The combination of factors iliac vein thrombophlebitis, psoas muscle abscess, diskitis/spondylitis with ARDS makes cavitary pulmonary disease a challenging perspective. After a 6-week antimicrobial treatment, full anticoagulation, his clinical condition and image fi ndings improved, and he was recently admitted for physical rehabilitation. Major vessels thrombophlebitis should always be considered, when primary source of septic pulmonary emboli is not clear. This case illustrates the complexity of illness and complications that may arise from a source of infection as the one in this patient. Further therapeutic strategies were tailored accordingly.

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