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Gina - global initiative against asthma
 

Gina - global initiative against asthma

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  • That explains why I suddenly came down with sudden shortnessof breath and coughing in December 1996, just before my television show debuted. Then again in April 2003 with sudden COPD Symptoms in area that is a target site for pharmaceutical companes with 5 hospitals in a locale that only has about 150,000 in it's city of Syracuse, New York and 600,000 people in the county area. Not to mention that my name is Gina and I was a nurse interested in research. That also explins the insistence of a mental health diagnosises when I knew I wasn't a bahvioral problem or mentally ill to any level of needing tracking for dangerousness. Who do these people think they are?

    Thanks for ruining my life to include a chronic cough. Tell me, was this all in the name of God because in July 1997, St. Joseph Hospital documeted that I was religiously preoccupied when I wasn't and ironically, it was a Catholic hospital that diagnosed me as having Viral Bronchitis with an 02 sat of 100%. How is that possible? My 02 sat is about 96% when I checked it the year before.

    The following year Assetti Center did listen to me and others that Ammonia poisoning was being done in the area.They diagnosised me as having Asthma secondary to the Ammonia poisoning. My lung capacities before going into the area in 2003 were good, then I had hte chest xray that showed COPD in April 2003, then my PFTS were good in August as if the COPD suddenly resolved itself. I believe it did because I felt good. Then in Septemebr 2003, again I had a sudden illness of an URI. I left Syracuse, New York and my lungs and Chest X-rays were normal again. How does that figure? Two states checked my Chest x-rys and blood gases and they were alright. I came back to Syracuse and suddenly my lungs acted up again. I smoke alot less than I use to and really it isn't a factor in the irrationality of the symptoms and the testings. In 2008, suddenly I blew a PFT as a 53 year old women would when I had laryngitis that they diagnosed as Asthma. I leftthe area to have a scope done, what they found was that they spayed Afrin in my nostrils that cleared up the sinuc congestion. The Scope found that there was somethign other than smoking and the typical acid reflux causing it. I came back to Central New York and suddenly they wanted to call what I was going through 'disorganized Schizophrenia,' anyone knows that knows the history of the mental health foundation, that silencing of a human being is done through committing them to an asylum. Am I crazy? No, I've been a nurse for over 20 years, I know real symptoms, especially my own, when theyfrom a real illness and not a created one.

    Not to mention my grandmother not being able to breathe and dying in 2003. When will they ever learn that human beings are not for research consumption unless consented to and my family never consented to be subjects of any research. My grandmother wasn't even a DNR nd they gave her morphine when she had shortness of breath. She didn't have Astma nor did she ever smoke.

    IF you want to name something GIna, then take my advice and look at the Central York area at the COPD, Asthma, Viral Bronchitis, TB and URI rates all inconsistent after Asthma rates went up 24% years ago, along with the cancer rates, mostly in children and blamed the 'dirt' being dug up as the culprit as a new mall was being built.

    I believe it has to do with chemcials being ingested, as they always said, this is a test market area. Maybe it is Global Initiative for Asthma. The fact of the matter is research has to get to the root of the problem before it could ever cure an illness.

    Let me clue you, this is a county that relies on the hospitals to pay it's bills. The inhalers make people worse because they breathe in deeper whatever it is that's an irritant in their lungs to begin with.

    Forgive my sarcasm, when i seen this, it answered a world of questions. At least I know now, my feeling of being on borrowed time is a reality due to me not having many friends left alive.

    If you want to research any area, research teh Syracuse, New York area because the lung illnesses and the cardiac symptoms are not making any sense, either is the follow care.

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    Gina - global initiative against asthma Gina - global initiative against asthma Presentation Transcript

    • G IN A lobal itiative for sthma
    • GINA Program Objectives
      • Increase appreciation of asthma as a global public health problem
      • Present key recommendations for diagnosis and management of asthma
      • Provide strategies to adapt recommendations to varying health needs, services, and resources
      • Identify areas for future investigation of particular significance to the global community
    • GINA Assembly
      • A network of individuals participating in the dissemination and implementation of asthma management programs at the local, national and regional level
      • GINA Assembly members are invited to meet with the GINA Executive Committee during the ATS and ERS meetings
    • United States United Kingdom Argentina Australia Brazil Austria Canada Chile Belgium China Denmark Colombia Croatia Germany Greece Ireland Italy Syria Hong Kong Japan India Korea Kyrgyzstan Moldova Macedonia Malta Netherlands New Zealand Poland Portugal Georgia Romania Russia Singapore Slovenia Saudi Arabia South Africa Spain Sweden Thailand Switzerland Ukraine Taiwan ROC Venezuela Vietnam Yugoslavia Albania Bangladesh France Mexico Turkey Czech Republic Lebanon Pakistan GINA Assembly Israel Slovakia
    • GINA Documents
      • Global Strategy for Asthma Management and Prevention (revised 2006)
      • Pocket Guide: Asthma Management and Prevention (revised 2006)
      • Pocket Guide: Asthma Management and Prevention in Children (revised 2006)
      • Guide for asthma patients and families
      • All materials are available on GINA web site www.ginasthma.org
    • Global Strategy for Asthma Management and Prevention
      • Evidence-based
      • Implementation oriented
        • Diagnosis
        • Management
        • Prevention
      • Outcomes can be evaluated
    • Global Strategy for Asthma Management and Prevention Evidence Category Sources of Evidence A Randomized clinical trials Rich body of data B Randomized clinical trials Limited body of data   C Non-randomized trials Observational studies D Panel judgment consensus
    • Global Strategy for Asthma Management and Prevention (2006)
      • Definition and Overview
      • Diagnosis and Classification
      • Asthma Medications
      • Asthma Management and Prevention Program
      • Implementation of Asthma Guidelines in Health Systems
      Revised 2006
    • Definition of Asthma
      • A chronic inflammatory disorder of the airways
      • Many cells and cellular elements play a role
      • Chronic inflammation is associated with airway hyperresponsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing
      • Widespread, variable, and often reversible airflow limitation
    • Source: Peter J. Barnes, MD Asthma Inflammation: Cells and Mediators
    • Mechanisms: Asthma Inflammation Source: Peter J. Barnes, MD
    • Source: Peter J. Barnes, MD Asthma Inflammation: Cells and Mediators
    • Burden of Asthma
      • Asthma is one of the most common chronic diseases worldwide with an estimated 300 million affected individuals
      • Prevalence increasing in many countries, especially in children
      • A major cause of school/work absence
    • Asthma Prevalence and Mortality Source : Masoli M et al. Allergy 2004
    • Risk Factors for Asthma
      • Host factors: predispose individuals to, or protect them from, developing asthma
      • Environmental factors: influence susceptibility to development of asthma in predisposed individuals, precipitate asthma exacerbations, and/or cause symptoms to persist
    • Factors that Exacerbate Asthma
      • Allergens
      • Respiratory infections
      • Exercise and hyperventilation
      • Weather changes
      • Sulfur dioxide
      • Food, additives, drugs
    • Factors that Influence Asthma Development and Expression
      • Host Factors
      • Genetic
      • - Atopy
      • - Airway hyperresponsiveness
      • Gender
      • Obesity
      • Environmental Factors
      • Indoor allergens
      • Outdoor allergens
      • Occupational sensitizers
      • Tobacco smoke
      • Air Pollution
      • Respiratory Infections
      • Diet
    • Is it Asthma?
      • Recurrent episodes of wheezing
      • Troublesome cough at night
      • Cough or wheeze after exercise
      • Cough, wheeze or chest tightness after exposure to airborne allergens or pollutants
      • Colds “go to the chest” or take more than 10 days to clear
    • Asthma Diagnosis
      • History and patterns of symptoms
      • Measurements of lung function
      • - Spirometry
      • - Peak expiratory flow
      • Measurement of airway responsiveness
      • Measurements of allergic status to identify risk factors
      • Extra measures may be required to diagnose asthma in children 5 years and younger and the elderly
    • Typical Spirometric (FEV 1 ) Tracings 1 Time (sec) 2 3 4 5 FEV 1 Volume Normal Subject Asthmatic (After Bronchodilator) Asthmatic (Before Bronchodilator) Note: Each FEV 1 curve represents the highest of three repeat measurements
    • Measuring Variability of Peak Expiratory Flow
    • Measuring Airway Responsiveness
    • Intermittent Symptoms less than once a week Brief exacerbations Nocturnal symptoms not more than twice a month • FEV1 or PEF ≥ 80% predicted • PEF or FEV1 variability < 20% Mild Persistent Symptoms more than once a week but less than once a day Exacerbations may affect activity and sleep Nocturnal symptoms more than twice a month • FEV1 or PEF ≥ 80% predicted • PEF or FEV1 variability < 20 – 30%
    • Moderate Persistent Symptoms daily Exacerbations may affect activity and sleep Nocturnal symptoms more than once a week Daily use of inhaled short-acting 2-agonist • FEV1 or PEF 60-80% predicted • PEF or FEV1 variability > 30% Severe Persistent Symptoms daily Frequent exacerbations Frequent nocturnal asthma symptoms Limitation of physical activities • FEV1 or PEF ≤ 60% predicted • PEF or FEV1 variability > 30%
    • Levels of Asthma Control 3 or more features of partly controlled asthma present in any week < 80% predicted or personal best (if known) on any day Normal Lung function (PEF or FEV 1 ) One or more / year 1 in any week None Exacerbation More than twice / week None (2 or less / week) Need for rescue / “reliever” treatment Any None Nocturnal symptoms / awakening Any None Limitations of activities More than twice / week None (2 or less / week) Daytime symptoms Uncontrolled Partly controlled (Any present in any week) Controlled (All of the following) Characteristic
    • 1. Develop Patient/Doctor Partnership 2. Identify and Reduce Exposure to Risk Factors 3. Assess, Treat and Monitor Asthma 4. Manage Asthma Exacerbations 5. Special Considerations Asthma Management and Prevention Program: Five Components Revised 2006
    • Asthma Management and Prevention Program Goals of Long-term Management
      • Achieve and maintain control of symptoms
      • Maintain normal activity levels, including exercise
      • Maintain pulmonary function as close to normal levels as possible
      • Prevent asthma exacerbations
      • Avoid adverse effects from asthma medications
      • Prevent asthma mortality
    • Asthma Management and Prevention Program
      • Asthma can be effectively controlled in most patients by intervening to suppress and reverse inflammation as well as treating bronchoconstriction and related symptoms
      • Early intervention to stop exposure to the risk factors that sensitized the airway may help improve the control of asthma and reduce medication needs.
      .
    • Asthma Management and Prevention Program
      • Although there is no cure for asthma, appropriate management that includes a partnership between the physician and the patient/family most often results in the achievement of control
      • Guidelines on asthma management should be available but adapted and adopted for local use by local asthma planning teams
      • Clear communication between health care professionals and asthma patients is key to enhancing compliance
      Asthma Management and Prevention Program Component 1: Develop Patient/Doctor Partnership
    • Asthma Management and Prevention Program Component 1: Develop Patient/Doctor Partnership
      • Educate continually
      • Include the family
      • Provide information about asthma
      • Provide training on self-management skills
      • Emphasize a partnership among health care providers, the patient, and the patient’s family
    • Asthma Management and Prevention Program Component 1: Develop Patient/Doctor Partnership
      • Key factors to facilitate communication:
      • Friendly demeanor
      • Interactive dialogue
      • Encouragement and praise
      • Provide appropriate information
      • Feedback and review
    • Your Regular Treatment: 1. Each day take ___________________________ 2. Before exercise, take _____________________ WHEN TO INCREASE TREATMENT Assess your level of Asthma Control In the past week have you had: Daytime asthma symptoms more than 2 times ? No Yes Activity or exercise limited by asthma? No Yes Waking at night because of asthma? No Yes The need to use your [rescue medication] more than 2 times? No Yes If you are monitoring peak flow, peak flow less than________? No Yes If you answered YES to three or more of these questions, your asthma is uncontrolled and you may need to step up your treatment. HOW TO INCREASE TREATMENT STEP-UP your treatment as follows and assess improvement every day: ____________________________________________ [Write in next treatment step here] Maintain this treatment for _____________ days [specify number] WHEN TO CALL THE DOCTOR/CLINIC . Call your doctor/clinic: _______________ [provide phone numbers] If you don’t respond in _________ days [specify number] ______________________________ [optional lines for additional instruction] EMERGENCY/SEVERE LOSS OF CONTROL  If you have severe shortness of breath, and can only speak in short sentences,  If you are having a severe attack of asthma and are frightened,  If you need your reliever medication more than every 4 hours and are not improving. 1. Take 2 to 4 puffs ___________ [reliever medication ] 2. Take ____mg of ____________ [oral glucocorticosteroid] 3. Seek medical help: Go to _____________________; Address___________________ Phone: _______________________ 4. Continue to use your _________[ reliever medication] until you are able to get medical help. Example Of Contents Of An Action Plan To Maintain Asthma Control
    • Asthma Management and Prevention Program Factors Involved in Non-Adherence
      • Medication Usage
      • Difficulties associated with inhalers
      • Complicated regimens
      • Fears about, or actual side effects
      • Cost
      • Distance to pharmacies
      • Non-Medication Factors
      • Misunderstanding/lack of information
      • Fears about side-effects
      • Inappropriate expectations
      • Underestimation of severity
      • Attitudes toward ill health
      • Cultural factors
      • Poor communication
    • Asthma Management and Prevention Program Component 2: Identify and Reduce Exposure to Risk Factors
      • Measures to prevent the development of asthma, and asthma exacerbations by avoiding or reducing exposure to risk factors should be implemented wherever possible.
      • Asthma exacerbations may be caused by a variety of risk factors – allergens, viral infections, pollutants and drugs.
      • Reducing exposure to some categories of risk factors improves the control of asthma and reduces medications needs.
      • Reduce exposure to indoor allergens
      • Avoid tobacco smoke
      • Avoid vehicle emission
      • Identify irritants in the workplace
      • Explore role of infections on asthma development, especially in children and young infants
      Asthma Management and Prevention Program Component 2: Identify and Reduce Exposure to Risk Factors
    • Asthma Management and Prevention Program Influenza Vaccination
      • Influenza vaccination should be provided to patients with asthma when vaccination of the general population is advised
      • However, routine influenza vaccination of children and adults with asthma does not appear to protect them from asthma exacerbations or improve asthma control
    • Asthma Management and Prevention Program Component 3: Assess, Treat and Monitor Asthma The goal of asthma treatment, to achieve and maintain clinical control, can be achieved in a majority of patients with a pharmacologic intervention strategy developed in partnership between the patient/family and the health care professional
    • Asthma Management and Prevention Program Component 3: Assess, Treat and Monitor Asthma
      • Depending on level of asthma control, the patient is assigned to one of five treatment steps
      • Treatment is adjusted in a continuous cycle driven by changes in asthma control status. The cycle involves:
      • - Assessing Asthma Control
      • - Treating to Achieve Control
      • - Monitoring to Maintain Control
      • A stepwise approach to pharmacological therapy is recommended
      • The aim is to accomplish the goals of therapy with the least possible medication
      • Although in many countries traditional methods of healing are used, their efficacy has not yet been established and their use can therefore not be recommended
      Asthma Management and Prevention Program Component 3: Assess, Treat and Monitor Asthma
      • The choice of treatment should be guided by:
      • Level of asthma control
      • Current treatment
      • Pharmacological properties and availability of the various forms of asthma treatment
      • Economic considerations
      • Cultural preferences and differing health care
      • systems need to be considered
      Asthma Management and Prevention Program Component 3: Assess, Treat and Monitor Asthma
      • The choice of treatment should be guided by:
      • Level of asthma control
      • Current treatment
      • Pharmacological properties and availability of the various forms of asthma treatment
      • Economic considerations
      • Cultural preferences and differing health care
      • systems need to be considered
      Asthma Management and Prevention Program Component 3: Assess, Treat and Monitor Asthma
    • Component 4: Asthma Management and Prevention Program Controller Medications
      • Inhaled glucocorticosteroids
      • Leukotriene modifiers
      • Long-acting inhaled β 2 -agonists
      • Systemic glucocorticosteroids
      • Theophylline
      • Cromones
      • Long-acting oral β 2 -agonists
      • Anti-IgE
      • Systemic glucocorticosteroids
    • Estimate Comparative Daily Dosages for Inhaled Glucocorticosteroids by Age
        • Drug Low Daily Dose (  g) Medium Daily Dose (  g) High Daily Dose (  g)
        • > 5 y Age < 5 y > 5 y Age < 5 y > 5 y Age < 5 y
      >1000 >500-1000 250-500 Budesonide-Neb Inhalation Suspension >1000 >400 600-1000 >200-400 200-600 100-200 Budesonide >800-1200 >400 > 400-800 >200-400 200-400 100-200 Mometasone furoate >2000 >1200 >1000-2000 >800-1200 400-1000 400-800 Triamcinolone acetonide >500 >500 >250-500 >200-500 100-250 100-200 Fluticasone >2000 >1250 >1000-2000 >750-1250 500-1000 500-750 Flunisolide >320-1280 >320 >160-320 >160-320 80 – 160 80-160 Ciclesonide >1000 >400 >500-1000 >200-400 200-500 100-200 Beclomethasone
    • Component 4: Asthma Management and Prevention Program Reliever Medications
        • Rapid-acting inhaled β 2 -agonists
        • Systemic glucocorticosteroids
        • Anticholinergics
        • Theophylline
        • Short-acting oral β 2 -agonists
    • Component 4: Asthma Management and Prevention Program Allergen-specific Immunotherapy
      • Greatest benefit of specific immunotherapy using allergen extracts has been obtained in the treatment of allergic rhinitis
      • The role of specific immunotherapy in asthma is limited
      • Specific immunotherapy should be considered only after strict environmental avoidance and pharmacologic intervention, including inhaled glucocorticosteroids, have failed to control asthma
      • Perform only by trained physician
    • controlled partly controlled uncontrolled exacerbation LEVEL OF CONTROL maintain and find lowest controlling step consider stepping up to gain control step up until controlled treat as exacerbation TREATMENT OF ACTION TREATMENT STEPS REDUCE INCREASE STEP 1 STEP 2 STEP 3 STEP 4 STEP 5 REDUCE INCREASE
    •  
    •  
      • Step 1 – As-needed reliever medication
      • Patients with occasional daytime symptoms of short duration
      • A rapid-acting inhaled β 2 -agonist is the recommended reliever treatment ( Evidence A )
      • When symptoms are more frequent, and/or worsen periodically, patients require regular controller treatment ( step 2 or higher)
      Treating to Achieve Asthma Control
    •  
      • Step 2 – Reliever medication plus a single controller
      • A low-dose inhaled glucocorticosteroid is recommended as the initial controller treatment for patients of all ages ( Evidence A )
      • Alternative controller medications include leukotriene modifiers ( Evidence A ) appropriate for patients unable/unwilling to use inhaled glucocorticosteroids
      Treating to Achieve Asthma Control
    •  
      • Step 3 – Reliever medication plus one or two controllers
      • For adults and adolescents, combine a low-dose inhaled glucocorticosteroid with an inhaled long-acting β 2 -agonist either in a combination inhaler device or as separate components ( Evidence A )
      • Inhaled long-acting β 2 -agonist must not be used as monotherapy
      • For children, increase to a medium-dose inhaled glucocorticosteroid ( Evidence A )
      Treating to Achieve Asthma Control
      • Additional Step 3 Options for Adolescents and Adults
      • Increase to medium-dose inhaled glucocorticosteroid ( Evidence A )
      • Low-dose inhaled glucocorticosteroid combined with leukotriene modifiers ( Evidence A )
      • Low-dose sustained-release theophylline ( Evidence B )
      Treating to Achieve Asthma Control
    •  
      • Step 4 – Reliever medication plus two or more controllers
      • Selection of treatment at Step 4 depends on prior selections at Steps 2 and 3
      • Where possible, patients not controlled on Step 3 treatments should be referred to a health professional with expertise in the management of asthma
      Treating to Achieve Asthma Control
      • Step 4 – Reliever medication plus two or more controllers
      • Medium- or high-dose inhaled glucocorticosteroid combined with a long-acting inhaled β 2 -agonist ( Evidence A )
      • Medium- or high-dose inhaled glucocorticosteroid combined with leukotriene modifiers ( Evidence A )
      • Low-dose sustained-release theophylline added to medium- or high-dose inhaled glucocorticosteroid combined with a long-acting inhaled β 2 -agonist ( Evidence B )
      Treating to Achieve Asthma Control
    •  
    • Treating to Achieve Asthma Control
      • Step 5 – Reliever medication plus additional controller options
      • Addition of oral glucocorticosteroids to other controller medications may be effective ( Evidence D ) but is associated with severe side effects ( Evidence A )
      • Addition of anti-IgE treatment to other controller medications improves control of allergic asthma when control has not been achieved on other medications ( Evidence A )
    • Treating to Maintain Asthma Control
      • When control as been achieved, ongoing monitoring is essential to:
      • - maintain control
      • - establish lowest step/dose treatment
      • Asthma control should be monitored by the health care professional and by the patient
    • Treating to Maintain Asthma Control Stepping down treatment when asthma is controlled
      • When controlled on medium- to high-dose inhaled glucocorticosteroids: 50% dose reduction at 3 month intervals ( Evidence B )
      • When controlled on low-dose inhaled glucocorticosteroids: switch to once-daily dosing ( Evidence A )
    • Treating to Maintain Asthma Control Stepping down treatment when asthma is controlled
      • When controlled on combination inhaled glucocorticosteroids and long-acting inhaled β 2 -agonist, reduce dose of inhaled glucocorticosteroid by 50% while continuing the long-acting β 2 -agonist ( Evidence B )
      • If control is maintained, reduce to low-dose inhaled glucocorticosteroids and stop long-acting β 2 -agonist ( Evidence D )
    • Treating to Maintain Asthma Control Stepping up treatment in response to loss of control
      • Rapid-onset, short-acting or long-acting inhaled β 2-agonist bronchodilators provide temporary relief.
      • Need for repeated dosing over more than one/two days signals need for possible increase in controller therapy
    • Treating to Maintain Asthma Control Stepping up treatment in response to loss of control
      • Use of a combination rapid and long-acting inhaled β 2 -agonist ( e.g., formoterol) and an inhaled glucocorticosteroid ( e.g., budesonide) in a single inhaler both as a controller and reliever is effecting in maintaining a high level of asthma control and reduces exacerbations ( Evidence A )
      • Doubling the dose of inhaled glucocortico-steroids is not effective, and is not recommended ( Evidence A )
    • Childhood and adult asthma share the same underlying mechanisms. However, because of processes of growth and development, effects of asthma treatments in children differ from those in adults. Asthma Management and Prevention Program Component 3: Assess, Treat and Monitor Asthma – Children 5 Years and Younger
    • Many asthma medications ( e.g. glucocorticosteroids, β 2 - agonists, theophylline) are metabolized faster in children than in adults, and younger children tend to metabolize medications faster than older children Asthma Management and Prevention Program Component 3: Assess, Treat and Monitor Asthma – Children 5 Years and Younger
      • Long-term treatment with inhaled glucocorticosteroids has not been shown to be associated with any increase in osteoporosis or bone fracture
      • Studies including a total of over 3,500 children treated for periods of 1 – 13 years have found no sustained adverse effect of inhaled glucocorticosteroids on growth
      Asthma Management and Prevention Program Component 3: Assess, Treat and Monitor Asthma – Children 5 Years and Younger
      • Rapid-acting inhaled β 2 -agonists are the most effective reliever therapy for children
      • These medications are the most effective bronchodilators available and are the treatment of choice for acute asthma symptoms
      Asthma Management and Prevention Program Component 3: Assess, Treat and Monitor Asthma – Children 5 Years and Younger
      • Exacerbations of asthma are episodes of progressive increase in shortness of breath, cough, wheezing, or chest tightness
      • Exacerbations are characterized by decreases in expiratory airflow that can be quantified and monitored by measurement of lung function (FEV 1 or PEF)
      • Severe exacerbations are potentially life-threatening and treatment requires close supervision
      Asthma Management and Prevention Program Component 4: Manage Asthma Exacerbations
      • Primary therapies for exacerbations:
      • Repetitive administration of rapid-acting inhaled β 2 -agonist
      • Early introduction of systemic glucocorticosteroids
      • Oxygen supplementation
      • Closely monitor response to treatment with serial
      • measures of lung function
      Asthma Management and Prevention Program Component 4: Manage Asthma Exacerbations
    • Asthma Management and Prevention Program Special Considerations
      • Special considerations are required to
      • manage asthma in relation to:
      • Pregnancy
      • Surgery
      • Rhinitis, sinusitis, and nasal polyps
      • Occupational asthma
      • Respiratory infections
      • Gastroesophageal reflux
      • Aspirin-induced asthma
      • Anaphylaxis and Asthma
    • THANK YOU