Curing Asthma Forever

Asthma Free Forever Ebook

With Asthma Free Forever, asthma sufferers all over the world will discover the best way to cure asthma easily, naturally, and permanently. This guide was written by Jerry Ericson, an alternative medical specialist as well as former asthma sufferer. Inside this guidebook, users will discover the techniques that helped the author cure his asthma without useless and harmful medications. Inside this guide, users will discover the methods that helped the author cure his asthma without useless and harmful medications. The e-book contains a guided program that walks asthma sufferers through the process step by step, without the need for doctors. The program does not involve medication, drug therapies, or over the counter solutions. Asthma Free Forever is based on finding a natural solution to the problem, therefore it does not have any side effects. The natural treatments that are suggested are suitable for all asthma sufferers regardless of their gender or age. Asthma Free Forever has helped hundreds of people with asthma reduce their symptoms quickly and get rid of this disease easily and forever. The main e-book is itself a good value, but the additional bonuses that teach people to adopt a healthy lifestyle are just another weapon against asthma. With this productArticle Search, asthma sufferers can take their first steps toward a healthy life. Read more here...

Asthma Free Forever Summary


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The author presents a well detailed summery of the major headings. As a professional in this field, I must say that the points shared in this book are precise.

All the testing and user reviews show that Asthma Free Forever is definitely legit and highly recommended.

Airway Inflammation and Hyperresponsiveness

Although the symptoms of asthma are intermittent, airway inflammation is chronic. Considerable variations in the pattern of inflammation may exist, resulting in pheno-typic differences.1 T-lymphocytes release cytokines that coordinate eosinophilic infiltration and IgE production by B-lymphocytes.9 Mast cells, eosinophils, macrophages, neutrophils, fibroblasts, and airway smooth muscle cells are also activated in asthma. Mast cells infiltrate airway smooth muscle and bronchial epithelium and may cause mucous gland hyperplasia. Proinflammatory mediators generated during mast cell AHR is the exaggerated ability of the airways to narrow in response to a variety of stimuli. AHR is a characteristic feature of asthma and is related to airway inflammation and structural changes in the airways.1 Treatment of airway inflammation with inhaled corticosteroids (ICS) attenuates AHR in asthma but does not eliminate it.1 Clinically, AHR manifests as increased variability of airway function. Although...

Factors Affecting Asthma Severity

Major factors that may contribute to the severity of asthma include allergens, environmental chemical exposures or pollution, and exposure to tobacco smoke. Up to 80 of asthmatics have symptoms of rhinitis, and treatment of rhinitis with intranasal cor- ticosteroids may relieve the symptoms. Gastroesophageal reflux has been associated with increased asthma symptoms, especially nighttime symptoms. Obesity has been associated with asthma persistence and severity. Nonselective P-blockers, including those in ophthalmic preparations, may cause asthma symptoms, and these agents should be avoided in asthmatics unless the bene fits of therapy outweigh the risks.1 In asthmatic patients requiring P-blocker therapy, a Pi-selective agent should be chosen. Because selectivity is dose related, the lowest effective dose should be used. P-blockers may inhibit P-agonist reversal of bronchos-pasm, and a larger dose of P-agonist or the use of an anticholinergic agent may be necessary to reverse...

Patient Care and Monitoring Chronic Asthma

Obtain a thorough medical history focusing on disease states that may worsen asthma severity. 2. Ask the patient about the frequency and severity of symptoms, when symptoms occur, and whether or not symptoms are associated with exposure to known allergens. Ask about previous emergency department visits and hospitalizations due to asthma. 5. Develop a patient education plan that fits the patient's needs. Educate about the differences between the asthmatic and normal lung and what happens to the lung during an asthma attack. Counsel the patient on how their medications work and differentiate between long-term control and quick relief medications. 8. Prepare a patient-specific self-monitoring plan and review it with the patient. Educate the patient on the signs and symptoms of asthma deterioration and when and how to take rescue actions. 11. Evaluate therapy on a regular basis. Assess the patient's control of asthma by evaluating the patient's impairment due to asthma and their risk for...

Acute Severe Asthma

Perform a brief medical history to determine the time of symptom onset, symptom severity, symptom severity in relation to previous exacerbations, current medications, previous emergency department visits or hospitalizations due to asthma, previous history of respiratory failure, and psychiatric or psychological disorders. 9. Restart the patient on maintenance therapy. Instruct the patient on what to do if asthma worsens and to follow-up with his her health care provider in 1 to 4 weeks.

Management of Asthma in Children

More than half of children with asthma develop symptoms before their fifth birthday. However, diagnosis can be difficult because there are no reliable tests for children at this age, and diagnosis must rely solely on clinical presentation. Among children younger than 5 years, the most common cause of asthma symptoms is a viral upper respiratory tract infection. Based on expert opinion, daily long-term control therapy should be initiated in young children who consistently require symptomatic treatment more than twice per week and those who experience severe exacerbations that occur less than 6 weeks apart. Therapy is recommended for children who had more than four episodes of wheezing in the past year that lasted more than 1 day and affected sleep and who have a positive asthma predictive index. A positive asthma predictive index is either one of two major risk factors (parental history of asthma or physician diagnosis of atopic dermatitis) or two of three minor risk factors (wheezing...

Management of Asthma Exacerbation

Asthma exacerbations consist of episodes of progressively worsening shortness of breath, cough, wheezing, or chest tightness. These exacerbations are characterized by decreases in FVC and PEVj that can be measured by peak-flow meters. Peak-flow monitoring can help grade the severity of an exacerbation. Early treatment is the best strategy for effective treatment of asthma exacerbations. Patients should receive a written action plan to guide self-management of exacerbation, especially patients with persistent asthma or any history of a severe exacerbation. Patients should be able to recognize the early indicators of an exacerbation, such as a decline in PEFR. There should be prompt communication between the clinician and patient during any abrupt worsening of asthma, as well as availability of a short course of systemic corticoste-roids even before this communication takes place. The goals of treating an exacerbation are correction of any significant hypoxemia, rapid reversal of...

Asthma Ease the Wheeze

Asthma affects more than 10 million Americans (3 million children and 7 million adults). Children under 16 and adults over 65 are more likely to have asthma. Hospitalizations due to this condition have increased 500 percent in the last 29 years, while the death rate in the U.S. from asthma has increased 45 percent in the past 10 years. Asthma is a condition that blocks the flow of air into your lungs. During an asthma attack, spasms in the muscles surrounding the bronchi (small airways in the lungs) make the air passages smaller. This makes you feel like you have to fight for every breath, and most people experience symptoms such as coughing, wheezing (the raspy, sucking sound as you breathe), and a feeling of tightness in the chest. These spasms of the airways are commonly triggered by hypersensitivity to environmental factors. Common Asthma Triggers There are several known causes of asthma, including the following Early-onset asthma (extrinsic) Begins in childhood, hereditary, often...

Oriental Medicines Answer to Asthma

Your child's individual symptoms of asthma determine the oriental diagnosis and treatment plan used. One of the most common pediatric asthma conditions that I see in my office translates into deficient spleen asthma. Weak digestion and excessive mucus characterize this. The cough produces a lot of phlegm, poor appetite, bloated upper abdomen, pale complexion, fatigue, loose or incomplete stools, and pale tongue.

Bronchial asthma Definition

Asthma, which is derived from the Greek ao0 ia, meaning short-drawn breath or panting, has until recently been defined as a disease characterized by an increased responsiveness of the trachea and bronchi to various stimuli and manifested by a widespread narrowing of the airways that changes in severity either spontaneously or as a result of therapy 1 . Although first highlighted in clinicopathologic studies of fatal asthma at the turn of the 20th century, it is only as a result of studies of bronchoalveolar lavage fluid, endobronchial biopsies and induced sputum over the past four decades that our appreciation and understanding of the inflammatory nature of the disease has increased 2,3 . This has resulted in a shift of emphasis away from airway smooth muscle dysfunction to a T-lymphocyte-modulated chronic desquamative eosinophilic bronchitis as the primary abnormality in asthma 4-6 . In the 1992 international consensus statement, asthma is now defined as 'a chronic inflammatory...

Asthma Etiology An Epigenetic Framework

In a genetics review, Wills-Karp and Ewart (2004) reported evidence of asthma susceptibility genes, which call to the fore the importance of identifying developmentally relevant environmental factors that through gene-environment interaction may promote gene expression and perhaps influence the course of asthma (Mrazek 2003). Onset of asthma in a genetically vulnerable child is likely determined by some complex interaction of genetic vulnerability (Wills-Karp and Ewart 2004) environmental exposure to respiratory infections, allergens, irritants, or environmental smoke (Busse and Lemanske 2001 Environmental Protection Agency 1992) and psychological influences such as maternal distress (Kozyrskyj et al. 2008) and stress (Wright et al. 2005). Problematic parenting appears to increase risk of asthma onset in children at genetic risk (Klinnert et al. 1994, 2001). Developmentally relevant stressful events and or the quality of caregiving may alter the emotional and physiological regulation...

Problems in Asthma Knowledge and Adherence

Compliance with medical regimens and asthma management play an important role in the course of illness (Bender 2006 Bender and Zhang 2008 Bender et al. 1998 McQuaid et al. 2003). Various factors, including emotional compromise in the child patient or the parent, may compromise adherence (Bender and Zhang 2008). Current asthma practice guidelines emphasize the importance of daily and regular monitoring of asthma symptoms and detailed action plans in the event of an attack (National Heart, Lung, and Blood Institute and National Asthma Education and Prevention Program 2007). Many of the recommendations include daily or weekly family routines, such as vacuuming the house once per week, monthly cleaning of duct systems, and monitoring airway peak flows. Families that are more capable of the organization of family routines have more effective management strategies (Fiese et al. 2005). Thus, families compromised by parental emotional disorder or marital distress are less likely to provide...

Bronchospasm Aetiology

General anaesthesia can alter airway resistance by influencing bronchomotor tone, lung volumes and bronchial secretions. Patients with increased airway reactivity from recent respiratory infection, asthma, atopy or smoking are more susceptible to bronchospasm during anaesthesia. Bronchospasm may be precipitated by insertion of an artificial airway during light anaesthesia, by stimulation of the carina or bronchi by a tracheal tube or by drugs causing p-blockade or release of histamine. Drug hypersensitivity, pulmonary aspiration and foreign bodies in the lower airway can also present as bronchospasm.

Anaesthesia for asthmatic patients

Elective surgery should proceed only if symptoms are optimally controlled. Premedication with the patient's usual bronchodilator therapy or an inhaled -agonist is recommended and the use of an anxiolytic should be considered. If regional anaesthesia is con-traindicated, use a general anaesthetic technique with minimal airway stimulation. If possible, avoid using drugs which release histamine and give all drugs slowly and after dilution. If tracheal intubation is necessary, ensure an adequate depth of anaesthesia. The provision of postoperative oxygen and maintenance bronchodilator therapy is essential.

Exerciseinduced bronchospasm EIB

It is well recognized that physical exercise has adverse effects in asthmatic subjects. In the 2nd century ad, Aretaeus of Cappadocia wrote 'If from running, gymnastic exercise, or any other work the breathing becomes difficult, it is called asthma' 8 , and the observation was repeated in the 17th century by the asthmatic physician, Sir John Floyer 'All exercise makes the asthmatic to breathe short and if the Exercise be continued it occasions a Fit' 9 . This phenomenon is described by the synonymous terms exercise-induced asthma (EIA) and exercise-induced bronchoconstriction (EIB). The breathing difficulties are due to bronchospasm, which can be detected by changes in the forced expiratory volume in 1 s (FEVj) on spirometry or in peak expiratory flow (PEF) using a peak flow meter. After a standardized bicycle ergometer or treadmill exercise protocol in the laboratory, the normal response in the postexercise period is a maximum fall in FEVl of less than 10 10 . When exercise testing...

Exercise Induced Bronchospasm

Exercise-induced asthma or, more accurately, exercise-induced bronchospasm (EIB) is a transient narrowing of the airways following vigorous exercise. Ninety percent of known asthmatics and 40 of patients with allergic rhinitis have bronchoconstriction caused or worsened by exercise (Feinstein et al., 1996). In some patients, the only manifestation of airway hyperresponsiveness is EIB, with up to 50 of athletes having EIB in some high-risk sports (Langdeau and Boulet, 2001). the addition of a leukotriene modifier (e.g., montelukast, 10 mg) taken at least 1 hour before exercise can provide additional relief (Coreno et al., 2000). Another treatment alternative is an inhaled mast cell stabilizer (e.g., cromolyn) before exercise. Inhaled corticosteroids are not as useful for acute prophylaxis because of their delayed onset of action, but can be very useful in patients with chronic persistent asthma and EIB. Any underlying chronic asthma or allergic rhinitis should also be optimally...

Treatment of Acute Severe Asthma

Manufacturing Center Excellence Model

The optimal treatment of acute severe asthma depends on the severity of the exacerbation. The patient's condition usually deteriorates over several hours, days, or weeks. Gradual deterioration may indicate failure of long-term controller therapy. However, rapid deterioration can occur in some patients these patients usually respond well to bronchodilator therapy.41 Severity at the time of the evaluation can be estimated by signs and symptoms or presenting PEF or FEV1 but patient response 30 minutes after inhalation of a bronchodilator is the best predictor of outcome. 4 O In acute severe asthma, early and appropriate intensification of therapy is important to resolve the exacerbation, prevent relapse, and prevent severe airflow obstruction in the future. Starting therapy at home allows for rapid initiation and early assessment of response (see Fig. 14-3). Patients should follow their written action plan as symptoms intensify or lung function deteriorates. Based on the initial response...

The Complex Roles of Anaphylatoxins in Allergic Asthma and Autoimmune Diseases

Abstract Complement has a long-recognized role as a lytic effector system that protects against microbial pathogens as well as a mediator of acute and chronic inflammatory responses. Many of the inflammatory properties related to complement activation can be related to the complement cleavage fragments C3a and C5a, the so-called anaphylatoxins. Cloning and subsequent gene targeting of their corresponding receptors, as well as generation of specific C3a and CSa inhibitors, have fueled new interest in studies aimed at defining the roles of the anaphylatoxins in inflammatory diseases. Traditionally, the anaphylatoxins have been considered mediators of end-stage effector mechanisms. However, recent data from animal models of allergic asthma suggest that C3a and C5a provide a critical link between innate and adaptive immunity. Further, the anaphylatoxins appear to form a sophisticated regulatory network together with immunoglobulin G Fc receptors that links regulatory events with effector...

Effects of Stress and Depression on Asthma

The effect of emotional distress on asthma has been controversial over the years. Although emotional compromise has an effect on adherence to appropriate medical management, robust evidence also indicates that direct psychobiological pathways and mechanisms link stress and emotions with disease activity (Chen and Miller 2007 B.D. Miller and Wood 2003 G.E. Miller and Chen 2006 Wright et al. 1998). Evidence links negative family emotional climate to child depression, emotional triggering of asthma episodes (Wood et al. 2007), and worse disease activity (Wood et al. 2006). Mounting evidence indicates that chronic and acute extreme stress contributes to the worsening of pediatric asthma (Chen and Miller 2007 Sandberg et al. 2000, 2004). The most significant stressors are family-related circumstances and relational pro cesses. A series of multimethod (self-report, clinician report, family observation) studies has demonstrated that the chronic stress of negative family emotional climate,...

Exercise Induced Asthma

The prevalence of exercise-induced asthma ranges from 9 to 50 , depending on the sport cited.21 The acute release of bron-choconstricting agents and the chronic inflammatory airway changes, both of which are complexly intertwined, suggest two pathways to target for prevention of exercise-induced asthma attacks. A recent Cochrane review confirms that albuterol, a short-acting beta agonist, is the number one treatment for exercise-induced asthma episodes. The bronchodilating effects of albuterol are superior in the acute setting to the anti-inflammatory effects of cromolyn (a mast cell stabilizer) or the anticholinergic effects of ipratropium.22 Appropriate use of albuterol must consider tolerance, timing of use, and ergogenic effects. Inhaled corticosteroids are standard therapy for patients with persistent asthma. While not well studied in exercise, the pulmonary delivery of inhaled corticosteroids has not shown any evidence of ergogenic or anabolic effects, and they are approved by...

Chronic Asthma

Therapy for chronic asthma is directed at maintaining long-term control of asthma using the least amount of medications and minimizing adverse effects.1 Treatment goals are to (a) prevent chronic and troublesome symptoms (b) require infrequent use (2 or fewer days week) of SABA for quick relief of symptoms (c) maintain normal or near-normal pulmonary function (d) maintain normal activity levels (e) meet patients' and families' expectations of satisfaction with asthma care (f) prevent exacerbations of asthma and the need for emergency department visits or hospitalizations (g) prevent progressive loss of lung function and (h) provide optimal pharmacotherapy with minimal or no adverse effects.


The disease called orthopnoia, wrote Aretaeus, is also called asthma because those who have paroxysms pant for breath (asthmainousi). The Greek term asthma, used by Homer for a gasping, painful breathing, had acquired a distinct medical sense by the time of Hippocrates. The two terms asthma and orthopnoia are not uncommon in ancient literature, but on the basis of the adjectival form, asthmatikos, a nonmedical usage (e.g., the labored panting of an athlete) may be suspected. Like many diseases, the etiology of asthma was explained in humoralistic terms. The cause, Aretaeus states, is the coldness and moistness of the pneuma but the matter is moist, cold, and glutinous. Airborne pollen and dust do not seem to have been implicated in the sometimes sudden onset of an allergic reaction, the latter a concept not explicitly associated with asthma in classical texts. It may be significant, however, that Hippocrates notes that asthmatic attacks are frequent in the autumn. Aretaeus's account...

Work Related Asthma

At least 10 of asthma cases in adults can be attributed to occupational exposures, so an occupational history should be obtained in every patient with asthma. Diagnostic criteria are the same as for other causes of asthma or airway obstruction, including spirometry (FEVj FVC ratio

Asthma in sports

After the disqualification of an asthmatic gold medallist in the 1972 Olympic Games for the use of a banned drug 51 , there has been an increased focus on accurate diagnosis and treatment of asthma in Olympic team athletes, especially from the United States and Australia. This interest has since encompassed ath letes at other competitive levels, and was further intensified in the 1990s following the observation that 37 of cross-country skiers finishing in the top 15 places in short-distance competitive events in the 1991 World Championship used antiasthmatic medication (Videman Tapio, American College of Sports Medicine meeting, May 1992). The relationship between asthma and sports appears to be dual in nature. It has long been recognized that asthmatics participating in sporting activities experience EIB. However, recent studies have highlighted high prevalences of chest tightness, cough, wheezing or prolonged shortness of breath and asthma in highly trained athletes, especially...


This may result from stimulation of the airway by inhaled material. It is commoner in asthmatic or bronchitic patients and in smokers. It may result directly from intrinsic asthma or may be part of an anaphylactic reaction. Several drugs used in anaesthetic practice may precipitate bronchospasm either by a direct effect on bronchial muscle or by releasing histamine these include barbiturates, -tubocurarine, morphine, mivacurium and atracurium. Treatment comprises the removal of any predisposing factor and the administration of oxygen and bronchodilators.


These are agents that cause the smooth muscle of the terminal bronchioles to relax, thus counteracting broncho-constriction and narrowing of the airway diameter. Two main types of bronchodilator are used in veterinary medicine Methylxanthines - work on the smooth muscle cells by interfering with their chemical composition, discouraging bronchoconstriction. They are not selective, so can cause a range of stimulatory side effects as they affect many other cells in the body. Examples include theophylline. As methylxanthines are metabolized by the mixed function oxidase system, the dose may need to be increased in patients concurrently being treated with other drugs metabolized by the same system.

Reactions resulting from fi blockade

Induction of bronchospasm in patients with asthma or chronic bronchitis who rely on sympathetically (P2) mediated bronchodilatation. Theoretically, Pi-selective drugs are less likely to aggravate bronchospasm in asthmatics, but as their selectivity is only relative, they should not be considered completely safe.

Conceptualizations of Chronic Illness

One of the controversies within the medical coping literature focuses on the use of a categorical versus a noncategorical approach to conceptualizing the childhood illness experience (R.J. Thompson and Gustafson 1996). In categorical approaches, illnesses are grouped in terms of specific diseases, such as inflammatory bowel disease or asthma. These approaches consider the different rates and presentations of psychological problems in childhood within each category of illness (e.g., cancer, heart disease). This method has the advantage of being able to identify important differences between conditions and to identify specific targets for intervention. However, as pediatric psychosomatic medicine has evolved, an increasing focus has been placed on the characteristics that pediatric illnesses have in com

The Psychosomatic Patient

There are many ways of dealing with psychosomatic patients. First, identify the disorder Do not miss the possible diagnosis of an affective or anxiety disorder. Treatment of somatization is directed toward teaching the patient to cope with the psychological problems. Be aware that somatization operates unconsciously the patient really is suffering. Above all, the patient should never be told that his or her problem is ''in your head.'' Anxiety, fear, and depression are the main psychological problems associated with psychosomatic illness. The list of associated common symptoms and illnesses is long and includes chest pain, headaches, peptic ulcer disease, ulcerative colitis, irritable bowel syndrome, nausea, vomiting, anorexia nervosa, urticaria, tachycardia, hypertension, asthma, migraine, muscle tension syndromes, obesity, rashes, and dizziness. Answers to an open-ended question such as ''What's been happening in your life '' often provide insight into the problems.

Standardized Assessment Measures in Health Related Quality of Life

Several approaches to HRQOL measurement are currently available. Several of these are classified as generic measures, in that they assess the construct in general terms applicable to many medical populations. Two popular generic measures for pediatric populations are the Pediatric Quality of Life Inventory (Varni et al. 2003) and the Child Health Questionnaire (Landgraf et al. 1996) (see Table 3-5). These have the advantages of painting a broad portrait of HRQOL and allowing researchers to compare HRQOL across different illnesses. However, generic measures may not provide the precision necessary to track change over time, which is of great importance in clinical settings. As a result, several illness-specific measures have been developed, such as the Pediatric Asthma Quality of Life Questionnaire (Juniper et al. 1996) and the Cystic Fibrosis Questionnaire (Modi and Quittner 2003). These provide more precise measurement of the health-related issues most relevant to a particular...

Anticholinergic drugs

The use of anticholinergic agents for their bronchodilator properties dates back two centuries when datura plants were smoked for the relief of asthma. Atropine was used later but the side-effects, particularly dry secretions, made it unpopular. Less soluble ammonia compounds such as ipratropium were then introduced. Ipratropium is active topically and there is little systemic absorption from the respiratory or gastrointestinal tract. It has been suggested that the cholinergic mechanism (increased intracellular cGMP) may be responsible for hyperreactive airways. Thus ipratropium is effective in both prevention and treatment of reflex bronchoconstriction. Mast cell stabilization has also been proposed as a complementary mechanism of action. The maximum effect occurs 30-60 min after inhalation. The effect may persist for up to 8 h.

Antiinflammatory Agents Steroids

Steroids remain the most effective anti-inflammatory agents for lung disease. A variety of mechanisms may be involved in achieving the anti-inflammatory effects (Table 10.8). There is growing evidence that hyperreactive airways are the result of an inflammatory process. Steroids reduce hyperreactivity of airways but have no direct bronchodilator effect. The anti-asthma property of an inhaled steroid is proportional to its anti-inflammatory potency. In addition to their anti-inflammatory actions, steroids sensitize p2-adrenoceptors to the effects of agonists, increase the receptor population and prevent tachyphylaxis.

Epidemiology And Etiology

Asthma is the most prevalent chronic disease of childhood, and it causes significant morbidity and mortality in both adults and children. Approximately 22.9 million people in the United States carry the diagnosis of asthma, and nearly 6.8 million of these are younger than 18 years of age. The highest prevalence is in children 5 to 17 Approximately 10.1 million workdays and 12.8 million school days are missed every year due to asthma.2 In 2005, there were 1.77 million emergency department visits and 488,594 hospital discharges related to asthma. Children have the highest rates of emergency department visits and hospitalizations. ' There were approximately 3,816 asthma-related deaths in 2004. The total number of asthma deaths have decreased every year since 1999. Asthma is also a significant economic burden in the United States, costing 19.7 billion in 2007. Prescription drugs are the single largest direct medical expenditure and account for 42 of direct medical costs. Costs increase...

Patient Encounter Part 3

What further information do you need to assess this patient's asthma control Patients with incomplete responses should contact their health care provider immediately for instructions. Those with a poor response should proceed directly to the emergency department.1 In the emergency department, baseline PEF measurements and oxygen saturation should be monitored. PEF should be monitored before and 15 to 20 minutes after bronchodilator administration. Treatment should be initiated as soon as lung function is assessed (Fig. 14-4). Multiple doses of inhaled ipratropium should be added to SABA therapy in patients with severe airflow obstruction.1 Dosages for emergency department and hospital use of quick-relief medications are shown in Table 14-4. Routine antibiotic use is not warranted because the primary infectious agents associated with asthma exacerbations are viruses.1 Antibiotics should be reserved for situations when bacterial infection is strongly suspected (e.g., fever and purulent...

Patient Encounter Part 4 Emergency Department Visit

RB is brought to the emergency department short of breath and unable to speak in complete sentences. The symptoms started approximately 1 hours ago, and she has already used four puffs of albuterol every 20 minutes for three doses. She has never been hospitalized for asthma previously. On exam, she has inspiratory and expiratory wheezes and appears to be in distress. She is leaning forward to breathe, pursing her lips, and has intercostal and supraclavicular retractions. Her heart rate is 120 bpm and her respiratory rate is 26 breaths per minute. A PEF measurement is 35 of predicted value and her O2 saturation is 87 . Patients with aspirin-sensitive asthma are usually adults and often present with the triad of rhinitis, nasal polyps, and asthma. In these patients, acute asthma may occur within minutes of ingesting aspirin or another nonsteroidal anti-inflammatory drug (NSAID). These patients should be counseled against using NS AIDs.1 Although acetaminophen is generally safe in this...

National Hearu Lung and Blood Institute

The role of T lymphocytes in the pathogenesis of asthma. J Allergy Clin Immunol 2003 111 450-463. 8. Robinson DS. The role of mast cells in asthma Induction of airway hyper-responsiveness by interaction with smooth muscle J Allergy Clin Immunol 2004 114 58-65. 9. Cohn L, Elias JA, Chupp GL. Asthma Mechanisms of disease persistence and progression. Annu Rev Immunol 2004 22 789-815. 10. Bradding P, Walls AF, Holgate ST. The role of the mast cell in the pathophysiology of asthma. J Allergy Clin Immunol 2006 117 1277-1284. 11. Lemanske RF Jr, Busse WW. Asthma. J Allergy Clin Immunol 2003 111 S502-S519. 12. Beckett PA, Howarth PH. Pharmacotherapy and airway remodeling in asthma Thorax 2003 58 163-174. 13. Bousquet J, Khaltaev N, Cruz AA, et al. Allergic rhinitis and its impact on asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2) LEN and AllerGen). Allergy 2008 63(Suppl 86) 8-160. 14. Rodrigo GJ, Rodrigo C, Hall JB. Acute...

Upon completion of the chapter the reader will be able to

0 Inflammation plays a key role in the pathophysiology of chronic obstructive pulmonary disease (COPD), but it differs from that seen in asthma therefore, the use of and response to anti-inflammatory medications are different. 'O' Bronchodilators are the mainstay of treatment for symptomatic COPD. They reduce symptoms and improve exercise tolerance and quality oflife. In patients with moderate to severe COPD, bronchodilators may reduce the rate of decline in pulmonary function.

Nonpharmacologic Therapy

Avoidance of risk factors), especially through smoking cessation influenza vaccination Short-acting inhaled bronchodilator when needed (e.g ipratropium, albuterol, or combination inhaler) ADD Add substitute oral theophylline ADD LABD, long acting bronchodilator (tioiropium6. salmeterol, or

Patients With Atypical GERD

In patients presenting with extraesophageal GERD syndromes such as laryngitis or asthma, treatment with twice-daily PPI therapy for 2 months is probably warranted when there is a concomitant esophageal GERD syndrome. Patients with suspected reflux chest pain syndrome should receive twice-daily PPI therapy after cardiac causes have been excluded. Manometry and pH or impedance pH monitoring should be considered in patients who do not respond to PPI therapy.2

Depression and Health Care Behaviors

The impact of depression on treatment adherence has been an important area of investigation. For physically ill children and adolescents, treatment nonadherence is a serious problem, resulting in significant morbidity and mortality (DiMatteo et al. 2000). The relationship between depression and poor treatment adherence has been demonstrated in many pediatric illnesses, including asthma (Norrish et al. 1977), HIV disease (Murphy et al. 2001), renal disease (Brownbridge and Fielding 1994 Simoni et al. 1997), and diabetes mellitus (Ciechanowski et al. 2000). Depression has also been associated with higher rates of adverse health risk behaviors, including overeating, smoking, physical inactivity (Goodman and Whitaker 2002), increased sexual risk behaviors (Lehrer et al. 2006), and substance abuse (Bukstein et al. 1989).

Etiology And Epidemiology

Oral contraceptives, hormone therapy, oral hypoglycemic agents, anticonvulsants, and opioids are other common therapies that can cause nausea and vomiting.1,6 Some medications, such as digoxin and theophylline, cause nausea and vomiting in a dose-related fashion. Nausea and vomiting may indicate higher-than-desired drug concentrations. Ethanol and other toxins also cause nausea and vomiting.

Increased susceptibility in the elderly

The alteration in the structure of blood vessels, such as thickening of the walls of the arteries with age-related arteriosclerosis, will prevent compensatory increases in blood flow that may be necessary (due to loss of elasticity) to prevent ill-health following toxic exposures. Similarly, chest or respiratory diseases such as emphysema or chronic bronchial asthma may prevent compensatory respiratory mechanisms coming into effect if respiration is compromised by toxic exposures.

Air pollution episodes involving sulphur dioxide

According to the UK's Advisory Group on the Medical Aspects of Air Pollution Episodes in 1992 (Department of Health 1992), during episodes of elevated sulphur dioxide concentrations in the air, those suffering from pre-existing respiratory diseases (particularly asthma) may need to take steps to reduce their exposure. The evidence reviewed indicated that although individuals not suffering from respiratory disease should not be affected by the kind of air pollution episodes of elevated concentrations of sulphur dioxide typically found in the UK, asthmatic patients were found to be more sensitive to exposure to sulphur dioxide. Sulphur dioxide pollution is also considered more harmful when particulate and other pollution concentrations are high (UK Air Quality Archive 2007). In parts of the UK, levels of sulphur dioxide can regularly exceed those at which effects of clinical significance, including tightness of the chest, coughing, and wheezing, have been demonstrated in these...

Beta Adrenergic Receptor Blockers

Tive heart failure), these differences mainly affect side effects, contraindications, and frequency of dosing. For example, nonselective agents may increase bron-chospasm in asthmatic patients. Lipophilic agents may have more central nervous system effects, such as sedation and depression. The type of metabolism affects plasma half-life in patients with renal or hepatic insufficiency. P-Blockers with ISA slow the heart rate less than P-blockers without ISA P-blockers with ISA are less likely to decrease HDL or increase triglycerides.

Water Exercises And Water Running

Water exercises may be prescribed as rehabilitation and alternative training for most injuries, unless the person has wounds, eczema or other skin disorders. Usually, a surgical wound requires two weeks of healing and any stitches to be removed before starting water exercises, due to the risk of infections. Water exercising allows an athlete to maintain or improve aerobic and anaerobic capacity if suffering injuries that do not allow full impact on hard surfaces. Water running and work-out exercises can be used as alternative training for most types of injuries, as you can see from the frequent green light in the 'exercise on prescription' summaries in chapter 4. An athlete who is immobilised in one limb can have a plastic brace, which allows water training, instead of a plaster one. Water exercising can improve the endurance and flexibility of asthmatic athletes and people with different disabilities. It is a superb alternative training method for disabled or elderly patients, where...

Inhalational anaesthetic agents

Diethyl ether has been abandoned in the West because of its flammability, but it remains in widespread use in less developed countries. As it has a higher therapeutic ratio than more modern agents, it is relatively safe for administration in the hands of unskilled individuals. Its use is limited because it is highly irritant to the respiratory tract and can cause coughing, breath holding and profuse secretions. However, at deeper levels it was at one time a recommended treatment for bronchospasm.

Smoking and Other Risk Factors for Lung Disease

Smoking cessation is the most important factor in preventing lung and cardiovascular disease and all-cause mortality. Avoidance of secondary exposure to smoke, especially in the household, is also important in preventing childhood asthma and infections as well as adult cancers (DHHS, 2006).

Epidemiology and Risk Factors

Asthma is the most common chronic disease of childhood and affects many adult patients as well. The prevalence of asthma is increasing rapidly worldwide. It now affects more than 300 million people and causes the loss of more than 15 million disability-adjusted life-years (DALY) each year (Global Initiative for Asthma, 2006). Asthma prevalence is increasing in many countries and is not decreasing globally, despite some indications of decreased emergency care utilization linked to improved care (Anandan et al., 2009). In the United States, National Health Interview Survey (NHIS) data (2002) suggest that 20 million Americans would report currently having asthma (72 per 1000 people). Asthma affects an estimated 6.1 million children nationally (83 per 1000). Across all age groups, asthma led to 1.9 million ED visits (National Hospital Ambulatory Medical Care Survey, 2002) and 4261 deaths in 2002, down from 4487 deaths in 2000 (National Vital Statistics System, 2002a). In 2003, asthma was...

Clinical Presentation and Diagnosis

A complete history in patients suspected of having asthma should include the frequency and severity of recent symptoms and should distinguish between daytime and nocturnal symptom frequency, a factor that is also important in staging asthma. A history of past or present smoking (tobacco or other drugs) is essential, as is an inquiry about current passive exposure to smokers in the household or occupational secondary exposure to tobacco smoke (e.g., bartenders, restaurant staff). The clinician should also inquire about activities, acute illnesses, or environmental exposures that trigger episodes, a family history of asthma or atopic disease, and a detailed occupational history. Some patients are also exposed to bronchial irritants through hobbies such as woodworking or oil painting. Symptomatically, patients can present with complaints of chronic or acute episodic shortness of breath, wheezing, chest tightness, or a chronic cough (often at night). If they already have a diagnosis of...

Delayed effects following an acute exposure

A relatively recent report relating to accidental exposure to chlorine gas suggests that chronic sequelae following acute exposure may be more frequent than previously anticipated a follow-up study in July 1999 on 20 individuals (previously exposed in 1995) indicated that 75 had residual lung volumes below 80 of their predicted value and nearly half the subjects tested for airway reactivity to methacholine had a greater than 15 decline in FEV (Schwartz et al. 1990). There is some evidence to suggest that a single, acute exposure to chlorine gas may cause reactive airways dysfunction syndrome (RADS), also known as irritant-induced asthma (Ayres and Baxter 2004 Winder 2001).

Hypersensitivity Pneumonitis

Figure 18-9 Causes of work-related asthma, 1993-1999. (From National institute for Occupational Safety and Health. Distribution of agent categories most often associated with work-related asthma cases for all four SENSOR reporting States California, Massachusetts, Michigan, New Jersey , 1993-1999. Worker Health Chartbook 2004.

The Health and Occupational Reporting

The Health and Occupational Reporting (THOR) is an example of a UK system for occupational disease surveillance. THOR activity at the Centre of Occupational and Environmental Health, University of Manchester has a range of surveillance programmes. It includes surveillance of work-related and occupational respiratory disease (SWORD), particularly occupational asthma, benign and malignant pleural disease, mesothelioma, lung cancer, and pneumoconiosis surveillance. The most common cause of occupational asthma in the UK consists of the di-isocyanates (used in various industries such as in 'twin-pack' spray painting). Other important asthma hazards include colophony fume (from soldering flux). The SWORD scheme successfully picked up trends such as an increase in asthma associated with exposure to latex, and thus helped in raising awareness and reducing the risks.

Clinical Presentation

Symptoms that bring patients to medical attention most often emanate from the lungs, skin, or the eyes (uveitis and lacrimal gland enlargement). Diagnosis of sarcoidosis may be delayed if symptoms are attributed to more common lung diseases such as asthma or chronic bronchitis (Judson et al., 2003). Pulmonary symptoms may result from bronchial obstruction, either external compression caused by adenopathy or granulomas within the airways. Progressive disease may cause damage to the lung parenchyma, with a restrictive pattern of pulmonary function and decreased diffusion capacity, consistent with progressive interstitial lung damage. Clinical features associated with a worse outcome include the presence of lupus pernio, chronic uveitis, hyper-calcemia or nephrocalcinosis, nasal mucosal involvement and bone cysts. Neurosarcoidosis and cardiac involvement can be especially challenging to diagnose.

Adrenergic Receptors in Pulmonary Medicine

All three subtypes of a1-adrenergic receptors (particularly the a1A-subtype) and all three subtypes of -adrenergic receptors are expressed in human lung at the mRNA level, but no major role in the regulation of human airway function has been described (49-53). Among the P-adrenergic receptors, P1- and P2-adrenergic receptors coexist in the human lung the P3-subtype appears to be absent (53). P2-Adrenergic receptors are more abundant than P1-adrenergic receptors in all pulmonary cell types (except in pulmonary blood vessels) and are apparently the only subtype on airway smooth muscle cells (53). Accordingly, relaxation of airway smooth muscle is a prototypical function of P2-adrenergic receptors, and P2-selective agonists have been used for many years as bronchodilator drugs in asthma, chronic obstructive pulmonary disease, and other pulmonary conditions. Short-acting P-adrenergic agonists, such as salbutamol or terbutaline, are well established as acute bronchodilators, whereas...

Epidemiological studies

Time-series studies examine the relationship between day-to-day changes in concentrations of pollutants and day-to-day changes in the counts of health (or ill-health)-related events such as deaths and admissions to hospital. These studies require very careful control of confounding factors that also vary on a day to day basis. The key confounding factor that varies in this way is ambient temperature. Associations between all the common pollutants (particles, ozone, nitrogen dioxide, sulphur dioxide, and carbon monoxide) and a range of effects, including deaths from cardiovascular and respiratory disease, hospital admissions for heart attacks, and worsening of chronic respiratory conditions and asthma attacks,

Diagnostic procedures in eczema herpeticum

In all EH cases, the patient's personal history and family history of concomitant atopic diseases, such as allergic rhinoconjunctivitis and bronchial asthma, as well as personal and environmental history of herpes labialis, should be well documented to allow further information about predisposing factors for EH. Serum IgE levels usually correlate with the severerity of AD.25

Clinical application

There are a number of medical indications for intravenous sedation, particularly if the patient has a condition that is aggravated by stress. This group includes those with asthma, epilepsy, hypertension and those with mild ischaemic heart disease. Intravenous sedation can also be useful in those with mental and physical special needs.

Conclusions and Future Perspective

The interindividual variability in responsiveness to adrenergic agonists and antagonists presents not only a major challenge, but also an important opportunity for the future use of such drugs. Part of this variability has a genetic basis (i.e., polymorphisms and other variants in the genes encoding the adrenergic receptor subtypes) (42,43,96-98). Although variation in the genes for the adrenergic receptors (or their signaling machinery) have the potential to influence tissue responsiveness to adrenergic drugs, variants in the genes that encode drug-metabolizing enzymes also may influence adrenergic drug responses. Another type of interindividual variability derives from differences in the regulation of adrenergic receptor expression and responsiveness that result from physiological factors such as age, pregnancy, and pathophysiological conditions such as heart failure or asthma and from drug treatment (6). This has been best documented for the heart (18) and airways (56). These...

Pulmonary Complications

Despite a lack of data demonstrating clear benefits of regional over general anesthesia in patients with preexisting lung disease, many anesthesiologists will choose regional anesthesia for their patients with advanced lung disease for surgery on the lower body to avoid the need to instrument the airway. Airway devices, like the endotracheal tube, may significantly irritate the airways in the patient with severe lung disease and stir up a host of unwanted side effects like bronchospasm (wheezing), increased coughing, and straining. Regional anesthesia usually avoids these problems.

Treatment Classification

Asthma is classified into four categories based on subjective symptoms of frequency and severity and objective measurements of pulmonary function (Figs. 20-1 and 20-2). The goal of asthma therapy is to maintain control of asthma with the least amount of medication and the least risk for adverse side effects. Obtaining control of asthma can be difficult to define for the patient and the clinician. Several keys to the definition of controlled asthma are prevention of troublesome symptoms (cough or wheezing), maintenance of normal pulmonary function, maintenance of normal activity levels, prevention of recurrent exacerbations, and meeting patients' and families' expectations of asthma care. Figure 20-2 Classification of asthma severity. (From Busse WW, Boushey HA, Camargo CA, et ai. Guidelines for the Diagnosis and Management of Asthma. National Asthma Education and Prevention Program, Expert Panel Report 3. NIH Pub No 08-5846, October 2007.) Classification of Asthma Severity 12 years of...

Location Of Tonsils And Adenoids

A runny nose can cause a cough, particularly at night as fluid drips down the back of the throat and causes irritation. A cough at night, even if it is not accompanied by wheezing, can be a symptom of asthma, and you should consult your doctor if you are concerned.

Impact of Lung Disease on the Patient

Since ancient times, clinicians have recognized that emotional factors play a role in the onset and maintenance of symptoms in bronchial asthma. Attacks of asthma can be provoked by a range of emotions fear, anger, anxiety, depression, guilt, frustration, and joy. It is the patient's attempt to suppress the emotion, rather than the emotion itself, that precipitates the asthmatic attack. A patient having an asthmatic attack becomes anxious and fearful, which tends to perpetuate the attack. Hyperventilation may contribute to the breathlessness of the frightened patient. Despite being given adequate medical therapy, these patients remain dyspneic. In such patients, it is the anxiety and its causes that require attention. They need continuing medical and psychologic support after an acute attack. As early as the 12th century, Maimonides recognized that ''mere diet and medical treatment cannot fully cure this disorder.'' Asthma in children presents a special problem. Anxiety,...

Respiration A Breath of Fresh

V Oriental medicine helps asthma sufferers breathe with confidence In this chapter, we give you hope of treating your awful allergies and asthma. Oriental Medicine once more comes to the rescue in the case of bronchitis. We'll take a look at the issues of allergies, their treatment, and prevention. Asthma and bronchitis sufferers will get tips on self-care techniques using acu-points and medical massage. Life can be challenging enough without struggling for each breath. Now it's time to begin your journey to better breathing.

Question 1 Was the reference standard an acceptable one

While many single tests (such as histopathologic examinations) are considered classic examples of reference standards, such tests do not always work for complex conditions. Sometimes, researchers resort to establishing disease presence using multiple criteria (e.g. the Jones criteria to diagnose rheumatic fever) 1 or even response to therapy (e.g. reversible airway obstruction to diagnose bronchial asthma) 2 . Whatever they choose, they must ensure that their reference standard defines disease in a way that is acceptable to medical practitioners.

Simulated Moving Bed Chromatography

Large-scale separation of chiral drugs (a priority in the pharmaceutical industry) can be achieved with this method. In simulated moving bed chromatography (SMBC) 6-12 columns containing a CSP are joined in a ring and the fluid is circulated using 4-5 pumps. As the racemate travels through the columns a zone of one enantiomer leads the rest of the injected sample while a zone of the opposite enantiomer lags behind. Using a computer-controlled system, some of the leading enantiomer, and, independently, some of the trailing enantiomer are withdrawn at intervals. As polysaccharide-based columns have a high loading capacity they have been widely used for chiral SMBC separations of up to 1.5 kg of racemate per kilogram of CSP per day. SMBC has been applied for the separation of a number of chiral drugs and intermediates such as propranolol, analgesic tramadol, antiasthmatic agent formoterol, antidepressant citalopram, and antitussive agent guaifenesine.

Reduction of Medication Errors Due To the Availability of Electronic Decision Support Tools At the Point of Prescribing

In the study by Nebeker,7 documenting 937 hospital admissions, it was found that 483 admissions had significant ADEs associated with them and that 27 of these were associated with medication. Of the medication-related ADEs, 61 were associated with prescribing errors and 25 with monitoring errors and the authors concluded that EP with decision support (DS) features would have a major impact on these error rates, by reducing inappropriate prescribing at the outset and by providing suitable monitoring tools when certain drugs are prescribed (e.g. digoxin, lithium, theophylline). Indeed, the consensus among electronic prescribing specialists is that decision support tools should be an integral part of EP systems, as they have the potential to add value to the system as a clinical tool. The above data suggest that DS functions are particularly valuable in reducing selection errors and inappro

Training type and effects

Any kind of physical exercise can be safely performed by almost all asthmatics, as EIB can be prevented or attenuated by regular anti-inflammatory treatment and the prophylactic use of pre-exercise warm-ups and b2-agonist or chromones 42 44 . Training programs should be based on the interval principle, as the airway response is less severe with intermittent than with continuous exercise 45 . Examples of useful activities are swimming, ball games, relay races and dancing. In addition to an amelioration of EIB, interval and endurance training result in significant improvements in the aerobic and anaerobic working capacities of asthmatics 46-49 . Minute ventilation is maintained under endurance training in asthmatics through a small increase in frequency with no change in tidal volume, which compensates for the airflow obstruction 50 .

Possible risk factors

There are three possible risk factors for asthma in sport Inhalation of seasonal allergens should be considered as a substantial risk factor in summer sports. A recent survey of elite Australian athletes in Summer Olympic disciplines revealed a history of seasonal allergic rhinoconjunctivitis with a positive skinprick test in 29 55 . In another study, Helenius et al. reported that atopic athletes had nearly a four-fold increased risk of developing bronchial hyperresponsiveness and more than a seven-fold risk of developing asthma, Table 4.5.1 Asthma prevalence in highly trained athletes. Table 4.5.1 Asthma prevalence in highly trained athletes. Asthma Exposure to low levels of pollutants like sulfur dioxide and ozone during exercise causes a marked bronchoconstriction and reduced ventilatory flow, compared to exposure at rest 29 . The airways are exposed to a much higher dose than at rest, because of a higher ven-tilatory rate and oronasal respiration. Cyclists are exposed to a wide...

Patient Care and Monitoring

Attempt to rule out complications or comorbid conditions that preclude self-care (asthma, sinusitis, otitis media with effusion, and possibly nasal polyposis) and or warrant referral to a physician (see Clinical Presentation and Diagnosis). Consider referral for patients with comorbid conditions, especially asthma. AAAAI American Academy of Allergy, Asthma and Immunology AC A AI Arne ric a n Col lege of A11 erg jj Asthma a n d ARIA Allergic Rhinitis and its Impact on Asthma BPH Benign prostatic hyper plasia hypertrophy BTC Behiml-the-counter CH PA Co n su mer H ea It h Pro t ect io n Agency H. Histamine type 1 (receptor)

Multiple choice questions

2 What is the expected prevalence of exercise-induced bronchoconstriction in previously untreated young asthmatics 3 What is the most important trigger for exercise-induced bronchoconstnction in asthmatic subjects 4 What are the main risk factors for asthma development in skiers 6 The preferred treatment of persistent asthma with EIB should be

Genetic Factors And Atopic Dermatitis In Food Allergy

Susceptibility for AD is most probably determined by a complex interaction of genetic and environmental factors.7 It has been shown that children of parents with AD have a higher risk of inheriting this condition, compared with offspring of parents with asthma or rhinitis, suggesting the presence of disease-specific genetic factors for AD.61 Further evidence for the importance of inherited factors has been gained from twin studies showing a concordance rate for monozygotic twins of 72 , compared with 23 for dizygotic twins.62 The search for candidate genes is hampered by the genetic complexity of AD, asthma, and atopy in general. Several strategies have been developed to unravel the genetic basis of AD, including gene linkage and association analysis. The recent completion of the first draft of the human genome has provided a large database of microsatellite genetic markers that can be utilized for linkage dysequilibrium studies between marker and disease. In order to maximize the...

Toxicity in Young Children A Special Case

Many cosmetics designed for use by children contain fragrance allergens (Rastogi et al., 1999). In Denmark, samples of children's cosmetics were found to contain geraniol, hydroxycitronellol, isoeugenol, and cinnamic alcohol (Rastogi et al., 1999). Children are more susceptible than adults to any chemical, so the increase in childhood asthma reported in recent years could be caused by fragrance components also found in fast foods. Aromatherapy therefore could be dangerous.

Complications and difficulties

This may occur if volatile anaesthetic agents are introduced rapidly, particularly in smokers with excessive bronchial secretions. Humidification and warming of gases may minimize the problem. Bronchospasm may accompany laryngospasm. Administration of bronchodilators may be required. These respiratory reflexes are induced more readily in the presence of, or shortly after, a respiratory tract infection.

Toxicity of chromium compounds

Studies of the effects of chronic occupational exposure to chromium compounds have proven difficult due to co-exposures to other toxic substances in the relevant working environments. Occupational exposure to some inhaled hexavalent chromium mists may cause nasal septal ulceration and perforation, respiratory irritation and inflammation, dyspnoea, cyanosis, and gastrointestinal, hepatic, renal, and haematological effects and lung cancer. Chronic exposure to hexavalent chromium compounds can also cause allergic responses (e.g. asthma and allergic dermatitis) in sensitized individuals. Chronic exposure to trivalent chromium resulted in weight loss, anaemia, liver dysfunction, and renal failure.

Epidemiology and Pathogenesis

The worldwide prevalence and severity of allergic asthma have increased dramatically in recent decades. In the U.S. alone, 15 million people suffer from asthma (1). The mechanisms underlying these epidemiological shifts remain obscure (2). Further, the development of effective therapies has lagged behind the growing prominence of the disease, and asthma morbidity and mortality continue to rise. Both epidemiologic and therapeutic investigation has been hindered by the lack of a detailed understanding of asthma pathogenesis. Recent advances have been driven by the insight that asthma is, in essence, an inflammatory disorder. The cardinal features of allergic asthma include airway hyperresponsiveness (AHR) to a variety of specific and nonspecific stimuli, excessive airway mucus production, pulmonary eosinophilia, and elevated concentrations of serum IgE. Although asthma is multifactorial in origin, it is generally accepted that it arises as a result of inappropriate immunological...

Anaphylatoxins Mode of Generation and Effector Functions

How complement is activated in asthma, whether during antigen priming or during the effector phase of the response, remains unclear. Anaphylatoxins may be generated by several different pathways, including (a) activation through the classical pathway as a result of allergen-antibody complex formation (necessarily an event downstream of Ag presentation unless due to natural antibodies) (b) activation of the lectin pathway through engagement of carbohydrate structures on allergens (c) alternative pathway activation on allergen surfaces (d) cleavage of C5 and C3 by proteases released from inflammatory cells and, most interestingly (e) direct cleavage of C3 and C5 by allergen proteases (20-22). Complement activation by any pathway results in formation of the anaphylatoxins, which were initially defined functionally by their activities on small blood vessels, smooth muscle, mast cells, and peripheral blood leukocytes. The anaphylatoxins have a plethora of proinflammatory actions, including...

Call An Ambulance

Possible cause A severe attack of asthma is a possible cause of these symptoms. action While waiting for the ambulance, sit upright with your elbows supported on a table or the back of a chair. Try to keep calm. If you have already been diagnosed with asthma and have your drugs with you, take two puffs of your relieving inhaler or follow the treatment plan given by your doctor. In hospital, you will be given oxygen and additional bronchodilator and corticosteroid drugs. action Although the damage is irreversible, your doctor may prescribe a bronchodilator drug to help relieve symptoms. You must stop smoking to prevent the condition worsening. Your peak flow rate is the maximum rate at which you can breathe out and is measured in litres per minute. Your doctor may measure your peak flow rate in order to assess the severity of respiratory conditions in which the airways become narrowed. Asthma is commonly diagnosed and monitored by measuring peak flow rate. You may be given a peak flow...

Psychosomatic Illness

Applying the continuum to respiratory diseases, at one extreme are those diseases with relatively strong psychosocial influence, such as vocal cord dysfunction (VCD). At the other extreme are diseases with strong biological contributions, such as cystic fibrosis. Diseases such as asthma range in between, depending on the relative contribution of psychosocial and biological factors in the course of illness for a particular patient, at a particular period in his or her development. For example, a given patient may have asthma that is influenced by both emotional and environmental factors. However, if family conflict becomes intense and prolonged or the patient experiences a significant loss, then the proportionally increased psychosocial contribution to the disease process shifts the disease toward the psychosocial end of the continuum. This recognition of relative influences on the disease is crucial for effective intervention. In the examples described, giving more asthma medications...

Morbidity and Mortality

An estimated 6.7 million children are affected by asthma, representing approximately 9 of children in the United States (Bloom and Cohen 2007). Asthma is the most common cause for school absence and hospitalization (Akinbami 2007). In 2005, children with asthma had 12.8 million physician office visits, 1.3 million hospital outpatient visits, and nearly 1.8 million emergency room visits (Cherry et al. 2007). Although a notable increase has occurred in asthma prevalence and morbidity over the past several decades, no explanation has been fully accepted. Some researchers have hypothesized that frequent antibiotic use and decreased exposure to early infections could alter immune balances, which could lead to increased likelihood of asthma onset. This is referred to as the hygiene hypothesis (Mattes and Karmaus 1999). Others have proposed that the increase is due to greater exposure to indoor allergens due to changes in lifestyle (Platts-Mills et al. 2000). Another possibility is that...

Products In The Induction Phase Of Type 1 Hypersensitivity Reactions

Recent experiments performed with up-to-date molecular biological techniques indicate that complement has a major role in the sensitization of patients to different allergens. Karp et al. (14) compared two groups of inbred mouse strains that exhibited low and high responsiveness to metacholine challenge. They have demonstrated that the C5 gene conferred decreased bronchial responsiveness following allergen challenge responsiveness of the genetically C5-deficient strains was significantly higher than that in the C5 sufficient animals. Authors explained their finding with the ability of C5a to inhibit IL-12 release from monocytes and macrophages and the consequent Th1 response. When C5 is absent, that is, no C5a can be generated, the balance of immune response switches toward the Th2 type response that is characteristic of allergy. In accordance with this observation, at genome-wide scanning of asthma susceptibility loci it was found that among the asthma-associated genetic regions the...

Allopathic adulterants

Adulteration is a widespread practice and has been reported in Australia, Belgium, Canada, The Netherlands, New Zealand, the UK and the USA. In 1999, 8 out of 11 Chinese herbal creams available in London for the treatment of eczema were found to contain dexamethasone at concentrations inappropriate for use on the face or in children (Keane et al. 1999). The 1998 Californian survey of imported Asian patent medicines revealed that of the 257 products that were analysed for pharmaceuticals, 17 products contained pharmaceuticals that were not declared on the label (most commonly ephedrine, chlorpheniramine, methyltestosterone, and phenacetin) (Chan 2003). In India, 38 of 120 samples of alternative medicines that had been dispensed to patients suffering mainly from asthma and arthritis were found to be adulterated with steroids (Gupta et al. 2000).

Psychosocial and Emotional Complications

Emotional distress is frequently encountered in pediatric patients with asthma. Children with asthma demonstrate more internalizing symptoms relative to normative and control groups (Bender and Zhang 2008 Goodwin and Eaton 2005 Klinnert et al. 2000 Wamboldt et al. 1998). A meta-analysis of behavioral adjustment in children with asthma confirmed that, in general, children with asthma do have more emotional difficulties than their peers and that these difficulties are more pronounced in the internalizing domain (McQuaid et al. 2001). Based on a controlled study of a large sample of children ages 11-17 years with asthma (n 781) and healthy controls (n 598), Katon et al. (2007) reported that 16.3 of youth with asthma, compared with 8.6 of youth without asthma, met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (American Psychiatric Association 2000), criteria for one or more anxiety and depressive disorders. This finding demonstrates that the...

Formation of Complement Activation Products in Experimental Allergy Models

Several findings indicate that complement activation takes places on the allergen-exposed mucosa of allergic individuals. C3a generated during complement activation can lead to increased vascular permeability it markedly facilitates mucus formation in the lower parts of respiratory tract (20) and induces production and release of interleukin 1 by cultured human monocytes (21). Fraser et al. (22) in a guinea pig model, using trimellitic anhydride (TMA), (a small molecular weight industrial compound that can cause asthma-like symptoms in humans), could directly prove the role of complement in the allergic response of the lung. Depletion of complement by cobra venom factor in the animals prior to their exposition to TMA prevented inflammatory cell infiltration in TMA-induced asthma.

Stress Reduction Programs and Psychosocial Intervention

Chronic stress, acute trauma, and emotional compromise in the child, caregivers, or family affect asthma outcomes through impairment of adherence and direct psychobiological pathways. Therefore, interventions that target stress, emotional compromise, and family relational distress are likely to improve adherence- and stress-compromised asthma disease. Despite the lack of truly evidence-based psychosocial treatments for asthma, several avenues of intervention are promising. Psychophysiological treatment interventions, including relaxation training and biofeedback, have promise, but little research to date has evaluated their use with children (McQuaid and Nassau 1999). These treatments are based on targeting psychobiological mechanisms, such as autonomic dys-regulation, that contribute to airway constriction through vagal cholinergic pathways (Lehrer et al. 2004). More research is needed on interventions targeting specific asthma-relevant psychobiological stress responses. Researchers...

Clinical features

Bullae, emphysema, asthma high inflation pressures occur intraoperatively. Examination may demonstrate unequal air entry and or chest movement, bronchospasm, surgical emphysema or mediastinal shift. Chest X-ray examination provides a definitive diagnosis (caution below).

Extracellular Targets

Notable extracellular proteins that play a role in inflammation include cytokines, chemokines, and antibodies. Wiegand et al. (1996) selected aptamers to IgE, a mediator of local inflammation which can cause allergies, atopic dermatitis, and asthma when overexpressed in atopic individuals (Sutton and Gould, 1993). Allergen-specific IgE binds to its high-affinity receptor, FceR1, on the surface of mast cells and basophils, which in turn activates the cells and results in degranulation and release of proinflammatory mediators. IgE-directed aptamers block IgE binding to FceR1, and inhibit degranulation in vitro. In another application, Rhodes et al. (2000) sought an inhibitor of oncostatin M (OSM), a potent proin-flammatory cytokine that may be a key mediator of rheumatoid arthritis (Plater-Zyberk et al., 2001). The authors showed that an aptamer to OSM specifically inhibited OSM receptor binding and receptor activation in vitro. The same group developed an aptamer against MCP-1, a CC...

Clinical features Table 4014

Coughing, skin erythema, difficulty with ventilation or loss of a palpable pulse are often the first signs in severe reactions. Cardiovascular collapse, bronchospasm and angio-oedema are the most common clinical features. Reactions involving major involvement of a single physiological system are common, e.g. bradycardia and profound hypotension with no evidence of bronchospasm or angio-oedema. Erythema of the skin may be shortlived or absent because cyanosis from poor tissue perfusion and hypoxaemia may be profound. The awake patient may experience a sense of impending doom, dyspnoea, nausea and vomiting. The differential diagnosis should include anaesthetic drug overdose and other causes of bronchospasm, hypotension or hypoxaemia.

Dietary prevention of food allergies and atopic dermatitis

Significantly with regard to socioeconomic and atopic sta-tus.42 It therefore remains unclear from this study whether early cow's milk feeding truly represents a risk factor for the development of AD or whether the early introduction of solid foods may to some extent account for the difference in AD prevalence between groups. Studies on the effect of early diet on the development of asthma have found no relationship between formula-feeding and asthma or atopy.129 In summary, there is at this stage no conclusive evidence that exclusive breast-feeding does prevent the onset of atopy.130

In the Regulation of Smooth Muscle Tone

In the lung, activation of P-ARs leads to relaxation of airway smooth muscle. Many, if not most, of the different cell types within the lung have been shown to express P2-AR on the cell surface. There is also significant P1-AR expression, constituting about 20 of total P-AR in human lung but no P3-AR is detectable. P2-ARs have thus been implicated in the regulation of many aspects of lung function (43). Clinically, P-agonists have been used for treating patients with asthma however, chronic treatment with P-agonists also leads to increased sensitivity to airway constriction (hyperactivity) drugs, such as muscarinuc receptor agonists. Unexpectedly, mice lacking both P1- and P2-ARs had markedly decreased bronchoconstrictive responses to the muscarinic receptor agonist methacholine and other Gq-coupled receptor agonists (44). Moreover, the lack of P-AR signaling leads to increased expression of phospholipase C-P1, a downstream component of Gq-coupled receptor signaling pathways and low...

Why Treat Them Theyre Only Addicts

Drug addiction is similar to cardiovascular disease. The emotional and treatment cost is great. The patients have initiated their disease and are at least partly to blame. They have some control over their behavior, and a lifestyle change is needed. Treatment is both behavioral and medical. Sometimes treatment doesn't improve things and the addicts continue drug use. Perhaps their habits, environmental pressures, inherited traits, and other factors are so strong that we haven't yet found a way to beat them. In spite of the similarity, cardiovascular disease carries much less blame and stigma than addiction. Addicts deserve the same help and attention as anyone with any kind of brain disorder or disease.1 Unfortunately, many addicts don't want their drug use known. The fear of being stigmatized prevents many from seeking and sticking with treatment. What can we do to help We can develop a more compassionate and supportive attitude about addiction and treatment, and we all can try to...

Eczema Ditch the Itch

Asthma and allergies seem to be a troublesome twosome that may accompany your eczema. The pattern I often see is an infant who develops or is born with eczema and is diagnosed with allergic asthma by the time he or she is four or five 5 ears old. If you or your child have eczema, please refer to Chapter 14, Childhood Conditions Pass the Owner's Manual, for guidance on asthma treatment and prevention.

Experience of Nonmedical Prescribing

Some examples of clinics led by non-medical independent prescribers that have been reported in the literature are sexual health clinics, diabetes clinics and asthma clinics run by primary care nurses and diabetes clinics and rheumatology clinics run by specialist hospital pharmacists34 .

Assessing suitability of crossover trials

Cross-over trials are suitable for evaluating interventions with a temporary effect in the treatment of stable, chronic conditions. They are employed, for example, in the study of interventions to relieve asthma and epilepsy. They are not appropriate when an intervention can have a lasting effect that compromises entry to subsequent periods of the trial, or when a disease has a rapid evolution. The advantages of cross-over trials must be weighed against their disadvantages. The principal problem associated with cross-over trials is that of carry-over (a type of period-by-intervention interaction). Carry-over is the situation in which the effects of an intervention given in one period persist into a subsequent period, thus interfering with the effects of a different subsequent intervention. Many cross-over trials include a period between interventions known as a washout period as a means of reducing carry-over. If a primary outcome is irreversible (for example mortality, or pregnancy...

Allergic Conjunctivitis

Cromolyn sodium 4 and olopatadine hydrochloride (Patanol) are effective mast cell stabilizers. Ketorolac tro-methamine (Acular), azelastine hydrochloride (Optivar), and lodoxamide tromethamine (Alomide) are also reasonable options for managing allergic conjunctivitis. Systemic allergy medications may cause allergic conjunctivitis to manifest because of reduced tear film production.

How Does Sensitization To Inhalant Allergens Occur

Indeed, early studies have shown that inhalation of house dust or pollen extract can provoke exacerbations of dermatitis.86 More recently, Tupker et al87 demonstrated pruritic, erythematous skin lesions in 9 of 20 AD patients after placebo-controlled bronchial provocation with house dust mite. All the responders had a history of asthma, an early bronchial reaction after allergen challenge, and an elevated total IgE level, suggesting that the respiratory route is especially relevant to this subset of AD patients. Brinkman et al88 could extend this finding showing that skin rashes could be also triggered by inhalation of cat allergen or tree pollen and that these flare-ups were more pronounced in patients with concomitant allergic asthma than in patients who suffered from AD alone. A possible explanation of this phenomenon is that allergen-induced inflammation in the airways might cause the release of mediators from activated inflammatory cells for possible distribution to the skin,...

Andrea D Eckhart and Walter J Koch Summary

Adrenergic receptor (AR) signaling is a key regulator of normal cardiopulmonary homeostasis. Under pathophysiological conditions, such as heart failure, asthma, and hypertension, there are alterations in the signaling cascades. Advances in the ability to manipulate the adenovi-ral genome have allowed the development of gene therapy in which transgenes of interest are inserted into the adenovirus and transferred to mammals in an organ-specific manner based on delivery methods. These transgenes have included components of the AR signaling pathway that have gone awry at the level of the AR itself or the G protein it activates, the G protein-coupled receptor kinases (GRKs), and regulators of G protein signaling (RGS) proteins that regulate AR desensitiza-tion, or the adenylyl cyclase that subsequently activates protein kinase A activity. The use of these vectors in both the heart and the lung has offered promising novel benefits for animal models of disease, including heart failure and...

Nanoparticles in air pollution

Although the term 'nanotoxicology' did not really exist prior to 2004, research into the hazards of particles within the nanoscale did exist. Much of this research was focused on the potential risks associated with inhalation of particulate air pollution known as PM10. PM stands for particulate matter, while the 10 refers to 10 m, the largest particle size that can be inhaled past the larynx and enter the small terminal airways of the lung. PM10 is the mass of particles generally less than 10 m in diameter per cubic metre of air. Elevated PM10 is associated with a number of adverse health effects, including increased asthma symptoms and asthma medication usage, increased hospital admissions and an increase in the death rate (Pope 2000). The increases in hospital admissions and deaths include respiratory causes such as asthma, smoking-related lung disease (chronic obstructive pulmonary disease, COPD), and bronchitis. The respiratory system is an obvious target for an inhaled pollutant,...

Potential Gene Therapy Targets 21 Adrenergic Receptors

Research to date has primarily focused on the P1- and P2-AR subtypes, and the role of the P3-AR remains controversial (4). The P-AR system is compromised in both the failing heart (4) and asthmatic lungs (5). The alterations that take place in the P-AR system during the progression of heart failure are best characterized (6). As the heart begins to fail, compensatory mechanisms are initiated to maintain cardiac output and systemic blood pressure. One of these mechanisms involves the sympathetic nervous system, which increases its myocardial outflow of norepinephrine in an attempt to stimulate contractility (7), leading to P-AR desensitization. There is a reduction of cardiac P-AR density in the failing human heart, and the remaining receptors appear to be desensitized (8). P1-ARs have been shown to be selectively reduced, and P2-ARs are not altered (9,10). Not only has gene transfer of the P2-AR been successful in the improvement of heart function, P2-AR gene therapy has also been...

Locating and selecting studies with patientreported outcomes

Searching methods for PROs are the same as for other outcomes (see Chapter 6). Usually all reports retrieved by the review's search strategy will be examined to identify those that include the PROs of interest. Sometimes a separate, additional, PRO search might be used to supplement the standard strategy. For example, if a review of randomized trials and other studies in the area of asthma did not yield studies using PROs, a separate search could be performed to include search terms specific to PROs used in asthma, such as 'asthma-specific quality of life'. However, this relies on there being mention of the PROs in the electronic record within the databases searched.

What healthcare areas have used the IPD approach

IPD meta-analyses have an established history in cardiovascular disease and cancer, where the methodology has been developing steadily since the late 1980s. In cancer, for example, there are now more than 50 IPD meta-analyses of screening and treatment across a wide range of solid tumour sites and haematological malignancies (Clarke 1998). IPD have also been used in systematic reviews in many other fields (Simmonds 2005), including HIV infection, dementia, epilepsy, depression, malaria, hernia and asthma. The Cochrane Collaboration Individual Patient Data Meta-analysis Methods Group web site includes a database of ongoing and completed IPD reviews where further information can be found (see Box 18.6.a).

Safety and Tolerability

The safety of rituximab is mainly related to infusion toxicity, a toxicity most MAb have in common (Kimby 2005). These side effects are observed during the infusion or in the first hours after drug infusion and particularly for the first infusion. They include fever, chills, dizziness, nausea, pruritus, throat swelling, cough, fatigue, hypotension and transient bronchospasm in a majority of patients. These symptoms are part of the cytokine-release syndrome. Their intensity correlates with the number of circulating malignant cells at time of infusion. More severe infusional toxicity includes bronchospasm, angioedema and acute lung injury, often associated with high circulating cell counts or pre-existing cardiac or pulmonary disease.

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